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A client with Bell’s palsy is unable to fully close one eye. Which instruction is most important for the nurse to reinforce?

A client with known peptic ulcer disease suddenly reports severe abdominal pain, states “it feels like something ripped,” and is now lying still with shallow respirations. On assessment, the abdomen is rigid and boardlike. Which action is the priority?

A client with ALS reports increased difficulty swallowing during meals. Which action should the nurse take first?

A client with severe vomiting and diarrhea for 3 days is admitted with BP 86/54, dry mucous membranes, and tachycardia. BUN and creatinine are elevated, and urine output is 0.2 mL/kg/hr. Which action is the priority?

A client presents with progressive fatigue, pruritus, and abdominal distention. The nurse notes 2+ bilateral lower extremity edema, multiple spider-like vascular lesions on the chest, and yellowing of the sclera. Laboratory results show elevated bilirubin, low albumin, and prolonged PT/INR. Based on these assessment findings, the nurse suspects impairment of which organ system?

A client with a recent T5 spinal cord injury has warm, dry skin, hypotension, bradycardia, and low urine output. Reflexes remain intact. Which condition does the nurse suspect?

Which statement by a client with cirrhosis and ascites indicates correct understanding of dietary teaching?

A client with newly diagnosed diverticulosis asks about dietary changes. Which instruction is appropriate?

A client is admitted after a gasoline fire. On assessment, the nurse documents burns to the: Entire left leg  Anterior trunk Posterior right arm What is the client’s estimated %TBSA burned?

A client with chronic kidney disease, sepsis pneumonia, and lactic acidosis has a serum potassium of 6.9 mEq/L. They receive hemodialysis every Monday, Wednesday, and Friday but missed their last two sessions due to illness. Their ECG shows peaked T waves, a widened QRS, and an irregular rhythm. Which orders would the nurse anticipate to treat the hyperkalemia and cardiac irritability? Select all that apply.