While changing the dressing of a client with a leg ulcer, the nurse observes a red, tender, and swollen wound at the site of the lesion.
Before reporting this finding to the healthcare provider, the nurse should note which of the client's laboratory values?

The nurse is caring for a client who has only months predicted to live. The client avoids questions regarding plans for care.
What is the next approach for the nurse to use when discussing end of life issues with the client?

The nurse observes a new employee, an uncertified nursing assistant (UAP), checking the temperature using a tympanic thermometer. The UAP pulls the client's auricle up and back and prepares to insert the thermometer.
Which action should the nurse implement?

The nurse observes an unlicensed assistive personnel (UAP) feeding a client who had a cerebral vascular accident (CVA) and is at risk for aspiration.
Which action by the UAP should the nurse recognize indicates the need for additional teaching?

A postoperative client has been prescribed three different analgesics for different levels of pain.
What is the most important intervention the nurse should take when administering these medications to the client?

The nurse observes that a client is using accessory muscles. Which vital sign should the nurse obtain first?

The healthcare provider prescribes ear drops to an adult client with an ear infection.
Which exacting should the nurse follow?

A healthcare organization requires nurses to chart by exception. Which assessment should the nurse document?

The nurse is preparing to give an emergency sedative injection to an agitated client.
Which action by the nurse is inappropriate?

Which response by the nurse is most therapeutic?

A client who is on complete bedrest frequently calls the nurse for the bedpan to urinate.
Which action should the nurse take to evaluate the client for urinary retention?