A client is admitted with infection and a high fever. Which assessments by the nurse take priority? (Select all that apply.)
a. Blood pressure
b. Mental status
c. Pulse quality
d. Respiratory effort
e. Skin turgor
f. Bowel sounds
A, B, C, E
Dehydration can accompany fever, especially if the client is sweating profusely. Blood pressure, pulse quality, and skin turgor are assessments of fluid status. Mental status changes can accom-pany fluid losses, especially in older clients.
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First-level managers need skill in which of the following tasks?
A) Planning, organizing, and directing patient care B) Creating individual personnel development plans for staff C) Using the budget review process in staffing D) Directing the operation of several patient care units
A patient who has sustained a deep laceration while gardening requires sutures. Her last tetanus shot was more than 10 years ago. Based on this information, the patient will receive a tetanus immunization that will allow for the release of an:
A) Antibody B) Antigen C) Bacteria D) Virus
A physician has prescribed vasopressin to the client for regulating the reabsorption of water by the kidneys. Which of the following assessments should the nurse perform after the administration of vasopressin?
A) Observe for and report any evidence of edema, such as dyspnea. B) Measure and record the client's abdominal girth every hour. C) Observe the client for blanching of the skin, abdominal cramps, and nausea. D) Weigh the client every day to obtain a baseline weight.
In preparation for an evidence-based practice initiative that will address the spiritual care that is provided to patients and families, a group of nurses is collecting information on the evidence related to the clinical question, the context in
which it will be implemented, and the way in which the process will be facilitated. The nurses are most likely utilizing which of the following models for evidence-based practice implementation? A) Iowa model B) Advancing Research and Clinical practice through close Collaboration (ARCC) model C) Promoting Action on Research Implementation in Health Services (PARIHS) framework D) Johns Hopkins Nursing Evidence-Based Practice model