A nurse admits a client who is experiencing an exacerbation of heart failure. Which action should the nurse take first?

a. Assess the client's respiratory status.
b. Draw blood to assess the client's serum electrolytes.
c. Administer intravenous furosemide (Lasix).
d. Ask the client about current medications.


ANS: A
Assessment of respiratory and oxygenation status is the priority nursing intervention for the prevention of complications. Monitoring electrolytes, administering diuretics, and asking about current medications are important but do not take priority over assessing respiratory status.

Nursing

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a. Health Resource and Services Administra-tion (HRSA) b. State board of nursing c. Scope of practice d. USDHHS

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The nurse seeks to organize the data obtained from the client in a logical manner. What is the term used to describe this organization, which identifies relations between factors and symptoms in the database?

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