The Unlicensed assistive person (UAP) reports the client is complaining of headaches and the blood pressure (BP) is 170/110 mm Hg. Which actions would the nurse take first based on this information?

Which instructions would the nurse give to an older adult with decreased perception of touch? Select all that apply. 

The nurse is caring for a post operative patient who is receiving narcotics for pain management. The nurse notes abdominal distention and listens for bowel sounds.  Which of the following assessments describes hypoactive bowels sounds.

The patient consumed four ounces of orange juice, eight ounces of tea, three ounces of jello and two ounces of milk.  The patient has had 200 ml in IV fluids.  The nurse will record   ________ as oral intake in the electronic medical record.

A nurse is evaluating a nursing students understanding of arterial and venous clotting. The student demonstrates the correct understanding by identifying which of the following manifestations as indications of a venous clot. 

A patient presents to the vascular lab for a lower extremity venous duplex exam. The patient states they have Factor V Leiden thrombophilia. Under which component of Virchow’s triad does this risk factor fall under?

Bidirectional flow from incompetent valves in the perforator vein will:

A precepting nurse is evaluating a new graduate nurses’ understanding of oxygenation and ventilation in a client with respiratory failure. Which response by the new graduate nurse indicates the correct method to evaluate both oxygenation and ventilation? 

Which finding in a client with a diagnosis of stable angina is most important for the nurse to communicate to the health care provider?

The provider has put the patient on a clear liquid diet.  The nurse is observing the tray and recognizes which item is not permitted on a clear liquid diet?