When collecting data, the nurse understands which individual is the primary source of information regarding pain tolerance.

A nurse is caring for a patient in the endocrinologist outpatient clinic.

When completing the assessment at 0810, which of the findings listed below would require a follow-up by the nurse?

Click to highlight the statements in the assessment findings that require follow-up by the nurse.

• Axillary temperature 100.5° F
• Heart rate 105/min
• Respiratory rate 18/min

The client is 34 years of age. States she has a bowel movement after every meal, heat intolerance, and nervousness. The client has lost 20 pounds in the last month without dieting or a change in physical activity. She exercises 4-5 times per week for 45 minutes at a time. States at times during exercise, she experiences irregular heartbeat.

A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which assessment findings for this client.

The nurse is caring for a client who is admitted to the medical-surgical unit for gastrointestinal disorders. While conducting a focused assessment, the nurse prepares to lightly palpate the client's abdomen. Which part of the hand should the nurse use?

A client is receiving the diuretic hydrochlorothiazide. When evaluating the client's response to hydrochlorothiazide, which common nontherapeutic response is important for the nurse to monitor?

The nurse reviews the arterial blood gas (ABG) results of a client and notes the results:

pH 7.46 pH units, [normal range: 7.35-7.45]

Paco2 of 30 mm Hg (30 mmol/L), [normal range: 35-45]

HCO3- of 20 mEq/L (20 mmol/L). [normal range [22-26]

When analyzing the client's ABG results, which condition would the nurse determine the client is experiencing?

While completing a comprehensive assessment of a client who is admitted with chronic obstructive pulmonary disorder, the objective data revealed the client's nails appear convexed and wide with an angle greater than 160 degrees. How would the nurse document this finding?

A prescription reads morphine sulfate, 8 mg stat. The medication ampule reads morphine sulfate, 10mg/ml. The nurse prepares how many milliliters (mL) to administer the correct dose. Round to the nearest tenth.

The nurse is collecting a medical history on a 34-year old client. The client reports: "I take oral antibiotics whenever she gets a sore throat, because she cannot afford to lose any time at work". What is the nurse's best response?

You are examining a client with respiratory distress. Which physical assessment would best determine if the client has acute hypoxemia?

A nurse in the community clinic is providing care to a client who is anxious and hyperventilating. What should the nurse do to reduce the risk of respiratory alkalosis?