A nurse is caring for a 44-year-old client who was admitted with an elevated temperature and abdominal pain.  Medical history: The client reports “not feeling well” for 3 days. The client reports decreased appetite and generalized abdominal pain with nausea. No reports of vomiting or diarrhea. The client has a history of stage IV chronic kidney disease. The client’s baseline BUN with treatment is about 32 mg/dL, and creatinine is 3.0 mg/dL per nephrologist. The client currently completes continuous ambulatory peritoneal dialysis (CAPD) four times per day. The client lives alone and has 4 cats. Other pertinent history includes hypertension, diabetes, and neuropathy. The client has been noncompliant with health care provider visits and follow-up. Nurse’s Notes: 1000:   Admitted from the clinic with generalized abdominal pain. Reports pain as an 8 on a scale of 0 to 10. Generalized abdominal tenderness was noted upon palpation. Abdomen distended and rigid with decreased bowel sounds. Reports nausea but denies vomiting. Heart sounds distant and irregular. Respirations are labored with crackles throughout lung fields. Skin pale and cool with poor skin turgor.  3+ pitting edema on bilateral lower extremities. The client states they have not completed any dialysis for the past 24 hours due to weakness.  Vital signs: Temporal temperature 38.9º C (102º F)  Pulse 110 /min; irregular  Respirations 28/min; labored  Blood pressure 108/60 mm Hg right arm  Oxygen saturation 95% on room air  Diagnostic results: CBC                        Results                    Reference range RBC count 4.0/mm3 4.2 to 6.1/mm3 WBC count 17,000/mm3 5,000 to 10,000/mm3     Hgb 10 g/dL 12 to 18 g/dL Hct 20% 37% to 52% Platelets 160,000/mm3 150,000 to 400,000/mm3 Basic Metabolic Profile BUN 34 mg/dL 10 to 20 mg/dL Creatinine 3.0 mg/dL 0.5 to 1.3 mg/dL Total calcium 7 mg/dL 9.0 to 10.5 mg/dL Carbon dioxide 25 mEq/L 23 to 30 mEq/L Chloride 101 mEq/L 98 to 106 mEq/L Glucose 185 mg/dL 74 to 106 mg/dL Potassium 7.0 mEq/L 3.5 to 5 mEq/L Sodium 140 mEq/L 136 to 145 mEq/L Select the 5 client findings that require immediate follow-up.

The nurse administered 4 oz. of apple juice (15 grams) to an alert patient whose blood glucose was 62 mg/dL (reference: 70-140 mg/dL) per the ordered protocol. Fifteen minutes later, the blood glucose is 67 mg/dL (reference: 70-140 mg/dL). The patient remains alert. Which action should the nurse take first?

A client presented to the hospital 3 days ago with diabetic ketoacidosis. They were recently diagnosed with diabetes. The nurse is providing discharge teaching to the client. Which of the following statements, if made by the client, requires follow-up by the nurse?

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically with this disorder?

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Which of the following is a prerenal cause of acute kidney injury (AKI)?

A nurse is preparing to educate a client regarding apixaban (Eliquis). Which of the following is true regarding this medication?

A 77 year-old client with a new diagnosis of multiple myeloma says to the nurse “I don’t want to become a burden to my family.” The best reply by the nurse would be

Which nursing assessment of a 69-year-old patient is most important to monitor during thyroid replacement with levothyroxine (Synthroid)?

The nurse is caring for a patient who is on an insulin drip for diabetic ketoacidosis (DKA). The patient’s blood sugar 1 hour ago was 300 mg/dL. The patient’s blood sugar is now 239 mg/dL (reference: 70-140 mg/dL). Which of the following intravenous fluids would the nurse anticipate giving the patient at this time?