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A patient with acute gastrointestinal (GI) bleeding from a gastric ulcer is receiving a normal saline bolus at a rate of 500 ml/hr. Which assessment data obtained by the nurse are most important to communicate immediately to the health care provider?

A patient’s Arterial Blood Gas (ABG) results are as follows: pH 7.25, PaCO2 50 mmHg, HCO3 20 mEq/L. Which acid-base imbalance is present, and is there compensation?  

A pregnant client presents in labor at term gestation, having no prenatal care.  After birth, her infant is noted to be microcephalic, small for gestational age (SGA) with small eyes and a thin upper lip. Based on the nurse’s assessment, this client’s prenatal history may be positive for which substance?

A patient with acute pancreatitis has a nasogastric (NG) tube to low wall suction and diet order is nothing by mouth (NPO).  What information will the nurse teach the patient regarding the expected outcome of the treatments? (Select all that apply.)

While caring for a postoperative patient on the first postoperative day (POD 1), which information about the patient is most important to communicate to the health care provider?

Which patient is most at risk for placental abruption (abruptio placentae)?

Match the drug to the nursing considerations that are most relevant to this medication. 

The registered nurse (RN) is caring for a patient with a hypertensive crisis they receive an order to start sodium nitroprusside via IV infusion. Knowing that the patient is experiencing a serious medical problem and receiving a high risk medication, which nursing action would an the experienced nurse do to further assess the patients condition throughout the hypertensive crisis while receiving the medication?

Which techniques should the nurse use to assess for respiratory distress? (Select all that apply.)

A client who is 30 weeks pregnant is admitted to the Birthing Center with contractions every 3 to 4 minutes, -1 station, 50% effaced and 3 cm cervical dilation.  After starting an IV, the nurse administers betamethasone sodium phosphate (Celestone Phosphate) 2 ml IM.  The client asks the nurse why she is receiving the betamethasone.  Which response should the nurse offer?