Fluids & Electrolytes
The patient is admitted with dehydration but otherwise stable. What is the priority IV solution to adminsiter?
Isotonic
0.9%
The patient is ambulating in the hallway and reports chest pain. What is the priority?
Have them stop the activity/sit down
The patient's blood sugar is 47 and they cannot follow commands. What is the priority nursing intervention?
Administer IV glucagon
Consent was never obtained preoperatively. What is the priority?
Stop the procedure
The patient fell out of bed and is complaining of intense pain at their shoulder. What is the priority?
Immobilize
The patient with a sodium imbalance should be placed on what nursing precuations?
Fall risk
The patient with COPD was alert and oriented x 4 at the beginning of the shift however, they have become increasingly restless throughout the day. What is the priority nursing intervention?
check their Sp02
The patient with Type 1 DM has ketones in their urine and is asking if they can run in their scheduled marathon today. What is the priority response?
NO
In PACU the client is fading in and out of sleep but states they are nauseas. What is the priority?
Turn them on their side.
The patient post THA is asking how to best be positioned. What is the priority?
Do not allow more than a 90 degree angle and keep legs abducted.
The patient admitting K+ is 6.8. What is the priority?
Notify the provider, complete an EKG
What is the priority nursing hypothesis with acute chest pain?
Impaired perfusion
The patient with DM has numbness and tingling to both feet. What is the priority teaching?
Falls
Use a mirror to look at the feet
Foot care
The patient is a brittle diabetic. In PACU the patient's ABC assessment is stable. What is the next priority action?
Check their blood glucose level
The patient has an open humerus fracture. What is most concerning with this type of fracture?
Risk for infection
The patient is admitted for potential CHF after complaints only being comfortable sitting up. SpO2 is WNL as well as other vitals. What is the priority intervention?
weigh the patient
The patient with acute chest pain has had 2 doses of sublingual nitro. What is the nursing priority prior to administering dose 3.
Assess pain
Check their BP
The patient with hyperthyroidism reports feeling that their heart is racing and they have excessive diaphoresis. What is the priority action?
Provide a calming environment
Assess vitals
Notify the provider
The nurse is caring for the client who was just admitted to the postsurgical unit from the PACU after having a total thyroidectomy? The nurse should prioritize which action?
Check Sp02
What is the priority nursing intervention when caring for a patient with paget's disease?
Fall risk
Pain control
The provider has ordered an additional IV push dose of Lasix. What is the priority lab values to assess before administration?
K+
BUN/Cr
The nurse is reviewing the healthcare provider's orders for the client with right-sided heart failure on metoprolol and furosemide. The provider adds digoxin 0.125 mg daily to their medication regime due to worsening symptoms. Which action by the nurse would be the priority prior to administration of all 3 meds?
Check potassium
obtain HR and BP
The patient's blood glucose is 209 at meal time. What is the priority medication to administer.
insulin lispro
The patient reports drinking coffee on their car ride in for their outpatient procedure. What is the priority action?
Cancel the procedure.
The patient is complaining of increased pain and feeling of pressure underneath their cast. What is the priority?
Notify the provider