You want to make certain K.N. knows what “hold the next dose” means. What should you tell him?

The nurse is examining a client in the third trimester of pregnancy. Which finding would require immediate intervention by the nurse?

1. Pulse of 98 beats per minute. 2. Weight gain of 1.5 pounds in a month. 3. Blood pressure of 148/94 mmHg. 4. Respiratory rate of 26 per minute.

For the nurse to effectively and legally delegate, which document must be consulted and followed to reduce the likelihood of liability?

1. The American Nurses Association Bylaws 2. The National Council of State Boards of Nursing 3. The regulations of the state nurse practice acts 4. The rules of the governing specialty organization

An 11-year-old diagnosed with oppositional defiant disorder becomes angry over the rules at a residential treatment program and begins shouting at the nurse. What might be the best method to defuse the situation?

a. Say to the child, "Tell me how you're feeling right now.". b. Take the child swimming at the center's pool. c. Administer an anxiolytic medication. d. Call staff to seclude the child.

The nurse in the emergency department is caring for a client with a long history of schizophrenia

whose chief complaint is sores on her legs. As the nurse takes the history, the client gives vague answers to questions about eating and sleeping habits and activities of daily living. The nurse notes that the client's personal hygiene is poor and that she has a large canvas duffle bag with her. The nurse wonders if the client is a homeless person. The nurse should a. ask if the client has someone with her that the nurse might speak to. b. ask the client during the mental status examination to state her address. c. avoid mentioning the topic because it is not relevant to treatment of a physical problem. d. ask the client directly about her living arrangements.