The nurse has assessed the client, analyzed the data, and identified constipation as a patient health problem.
Which assessment cues would support constipation? Select all that apply.

A nurse is caring for a client with a wound on the lower extremity. What findings would the nurse observe that would indicate a wound infection?

The nurse is performing a head-to-toe assessment on a patient. The nurse uses their thumb and first finger to lift or pinch a fold of skin under the clavicle to check for skin turgor. Which of the following findings would be considered normal for this assessment?

A nurse is managing a patient's fluids and outputs over a shift. Here are the details:

• 0700: The nurse starts an IV of 0.45% Normal saline infusing at 100 mL/hr.
• 0900: The patient has coffee-ground emesis (vomit) measuring 300 mL.
• 1000: The nurse stops the IV of 0.45% Normal saline to administer an IV antibiotic. The antibiotic administered is Kefzol 1 g in 25 mL of D5W over 30 minutes.
• 1030: The antibiotic infusion stops, and the nurse resumes the IV fluid of 0.45% Normal saline at 100 mL/hr.
• 1100: The physician orders the insertion of an NG tube and intermittent suction. The nurse inserts the NG tube and connects it to intermittent suction.
• 1530: The patient voids another 350 mL and 200 mL. The nurse checks the NG tube canister and records the output for the shift as 300 mL.

Calculate the patient's total intake from 0700 to 1530.

Upon responding to the client's call bell, the nurse discovers the client's abdominal wound has been eviscerated. Initial nursing management includes calling the healthcare provider and which other initial action?

A nurse is teaching a home care client and the family about using prescribed oxygen. What is a critical factor in regard to safety that must be included in teaching?

The nurse is caring for a patient who is confused and agitated. The patient continues to get out of bed without assistance and is at high risk for falls. The nurse is considering alternatives to implement prior to applying restraints.

Of the following, which would the nurse NOT consider in the plan of care as an alternative to restraints?

The physician orders Lanoxin elixir 90 mcg PO every morning.

Drug available: Lanoxin elixir 0.05 mg/mL

How many mL will be given?

The nurse performed an assessment on a patient's upper extremities. All findings were within normal limits. Which reflects the most accurate and complete terminology used when documenting these normal results?

Which statement by a nurse would be the most therapeutic response to a patient who cannot decide if they want to receive recommended chemotherapy treatment?

A home care nurse is caring for a comatose patient who requires total care. A visitor stops by the house identifying as a family friend and inquires about the patient's condition and if there is anything they can do to help the family. How should the nurse respond to maintain HIPAA compliance?