Author: Anonymous

The nurse is caring for a patient with a history of left-sided congestive heart failure who is acutely short of breath. The nurse hears fine crackles throughout both lung fields and notes that the patient’s pulse oximetry is only 88% on 4 L of oxygen. What is the priority intervention of the nurse?

The nurse is caring for a patient who periodically has small streaks of fresh red blood in the stool. The patient denies abdominal pain or loss of appetite. The nurse identifies what to be the most likely cause of this patient’s bleeding?

Which patient issue should the nurse address first?

A nurse notes a patient has abnormal vital signs. What action by the nurse is best?

The nurse is providing care to a post-stroke patient on the rehabilitation floor with a nursing diagnosis of Impaired health maintenance. Which goal is most appropriate on day one?

The nurse receives a hand-off report on four patients. Which patient finding should the nurse assess first?

The nurse knows changes in which body system affect overall mobility increasing the propensity of falling?

A patient states, “I just don’t conform to my gender role.” What does the nurse understand about this statement?

A parent confides to the nurse that the parent’s 3-year-old son seems to be touching his genitals frequently. What response by the nurse is best?

The nurse is caring for a patient with a history of type 1 diabetes. Which assessment finding indicates to the nurse that the patient may not be compliant with the diabetic treatment regimen?