An elderly client admitted with pneumonia and dementia has attempted several times to pull out the IV and Foley catheter. The nurse obtains a prescription for bilateral soft wrist restraints. Which nursing action is most appropriate?

A patient with acute shortness of breath is admitted to the hospital. Which action will the nurse take during the initial assessment of the patient?

When making rounds the nurse identifies the following situation (refer to the attached diagram) with an  (intravenous piggy back, IVPB) infusion that is attached to a primary infusion.  The Piggyback infusion is empty. What should the nurse do first?  

The nurse is caring for a client with emphysema. Which of the following nursing interventions are appropriate? Select all that apply.

A 74-year old female is admitted to the Emergency room with increasing dyspnea, productive cough, and fatigue.   Nurses’ Notes       1000: Client arrives in Emergency Department with worsening shortness of breath over the past week, strong productive cough with green-tinged sputum, and fatigue. Client has a history of  chronic obstructive pulmonary disease -emphysema; has been using their “relief” inhaler at home with no relief of symptoms. Client lives independently at home and states they smoke approximately 1 pack of cigarettes per day. Ambulatory, alert and oriented x 4. Has coarse crackles auscultated in bilateral lower lung fields with a barrel chest appearance, using accessory muscles, expiratory wheeze on auscultation. Client states they have “less room” to take a deep breath. Clubbing noted in all digits bilaterally. Vital Signs       Time  1000   Oral Temp  99.0 F (37.2C)   Pulse 104   Respiratory Rate 27   Blood Pressure 157/86   Pulse oximeter  91% Room air   Pain  0   The nurse anticipates that multiple medication orders will be provided from the physician. In which statements regarding medications taken by a client diagnosed with COPD do the drug name and the drug category correctly match? Select all that apply.

When making rounds, the nurse finds a client with COPD slumped over a lunch tray. After determining the client is unresponsive and calling for help, what is the nurse’s first action?

A nurse is caring for a client with pneumonia who was prescribed ceftriaxone (Rocephin) oral suspension 600mg once daily. The medication label indicates that the strength is 125mg/mL. How many milliliters of medication will the nurse pour to administer the correct dose. State your answer as a whole number. Do not include mL in your answer.

The client diagnosed with a cold is taking diphenhydramine (Benedryl). Which statement indicates to the nurse the client needs additional teaching concerning this medication?

Which client will potentially experience a diminished or delayed response to inflammation and wound healing?

You are evaluating and assessing a patient with a diagnosis of chronic emphysema. The patient is receiving oxygen at a flow rate of 5 liters per minute by nasal cannula. Which finding concerns you immediately?