Author: Anonymous

A nurse is caring for a client with acute leukemia who received the first dose of chemotherapy 18 hours ago. Which assessment finding is most concerning for early tumor lysis syndrome? 

A client experienced a full-thickness burn 72 hours ago. The client’s vital signs are as follows: BP: 124/72 mmHg HR: 97/min Urine output: 50 mL/hr The nurse understands that the client is in the [phase] of burn management and anticipates [intervention] 

A client with decompensated cirrhosis is admitted with jaundice, confusion, and increasing abdominal distention. Which assessment finding requires immediate intervention?   

A nurse is caring for a client who has just arrived to the emergency department following a high-speed motor vehicle collision. The client is immobilized on a backboard with a cervical collar in place. The client is groaning, has blood and vomitus in the mouth, and cannot speak in full sentences.  Which action should the nurse take first?   

A 72-year-old male is admitted with acute respiratory failure and complaints of worsening fatigue, confusion, and shallow breathing. ABG results are as follows: pH: 7.28          PaCO₂: 68 mmHg       PaO₂: 83 mmHg          HCO₃: 26 mEq/L Normal Range pH: 7.35 – 7.45 PaCO2: 35- 45 PaO2: 80-100 HCO3: 22-26 The nurse understands this client is experiencing [interpretation] acute respiratory failure

A client is brought to the emergency department after a fall from a 32-foot ladder. The client is unresponsive to verbal stimuli, withdraws only to painful stimuli, and has incomprehensible words, resulting in a Glasgow Coma Scale (GCS) score of 6. The client is also noted to have shallow respirations and an absent gag reflex.  What is the most appropriate immediate nursing intervention?   

A nurse admits a 26-year-old client with type 1 diabetes presenting with diabetic ketoacidosis (DKA). Which of the following clinical findings should the nurse anticipate? Select all that apply.

A client develops hypotension, tachycardia, and agitation 3 hours after insertion of a subclavian triple lumen central venous catheter.  The client’s lung sounds are decreased on one side, their lips are slightly cyanotic, and tracheal deviation is present. The nurse realizes that this client is most likely experiencing which type of shock?   

Who escorts Hamlet on the voyage to England?

Complete the following famous line from Hamlet: Something is rotten in the state of . . .