Normal Range
What is normal blood pressure range
120/80
BP
blood pressure
A client admitted to the hospital with a diagnosis of cirrhosis has massive ascites and difficulty breathing. The nurse performs which intervention as a priority measure to assist the client with breathing?
elevates the head of the bed 60 degrees
When communicating with a client who speaks a different language, what is the best practice for the nurse to implement?
arrange for an interpreter to translate
Chest pain, fever, pulmonary consolidation on X-Ray
Pneumonia
What is Normal adult temperature
97-99 F
ABG
Arterial Blood Gas
A nurse is formulating a plan of care for a client receiving enteral feedings. The nurse identifies which nursing diagnosis as the highest priority for this client?
risk for aspiration
The nurse is preparing to insert a NG tube into a client. the nurse should place the client in which positing for insertion?
High Fowler
The patient IV site is cool, pale, and swollen, and the solution in not infusing. The nurse concludes that which complication has occurred?
Inflitration
What is normal range Intracranial pressure
10-15 mmHg
NWB
non weight bearing
An hour after admission to the nursery, the nurse observes a newborn baby having spontaneous jerky movements of the limbs. The infant’s mother had gestational diabetes mellitus (GDM) during pregnancy. As a nurse, what’s the FIRST action you should take?
Determine the blood glucose level.
A nurse is caring for a client ,while sitting in a chair, starts to experience a seizure which action does the nurse take ?
Lower the client to the floor and place a pad under their head
The nurse is caring for client with a nasogastric tube that is attached to low suction. The nurse monitors the clients, knowing that the client is at risk for which acid base disorder?
Metabolic alkalosis.
What is the healthy range for a persons BMI?
18.5 to 24.9
hx
History
A labor room nurse is caring for a client in labor with a known history of sickle cell anemia. Which priority action would the nurse implement to assist in preventing a sickle cell crisis from occurring during labor?
Administer prescribed oxygen throughout the labor
When you are monitoring your client who is now started on an intravenous antibiotic for an infection, you notice that the client is exhibiting signs of anaphylaxis. What is your first priority intervention?
Stop the intravenous flow
Sudden severe, deep, unrelenting LUQ pain, may spread to back , often begins when recurrent, aggravated by eating, not relieved by accompanying N/V
Pancreatitis
What is the normal range for WBCs
4500-1100 WBCs per microliter
D/C
discontinue
A nurse is caring for a client who has just been admitted following surgical evacution of a subdural hematoma. what is the nurse priority assessment?
Airway (ABCs)
You are precepting a new graduate nurse who will be administering an intramuscular injection to an adult client. The new graduate nurse identifies the gluteus maximum muscle by palpating it. What would you do?
Stop the nurse from administering the injection.
Weight loss, tremors, palpitations, exophthalmos
Hyperthyroidism