Increased heart rate.

Discomfort at the puncture site.

A nurse is monitoring a client following a thoracentesis.

The nurse should identify which of the following manifestations as a complication and contact the provider immediately?

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin’s effects?

A nurse is assessing a client who has a pneumothorax with a chest tube in place. For which of the following findings should the nurse notify the provider?

A nurse on a cardiac care unit is caring for a preschooler.

• Hospital Day 1, 17:38: Medication Administration Record.
• 20:15: Received 4-year-old child with an exacerbation of heart failure.
• Family reports history of congenital mitral stenosis.
• Breath sounds with wheezing noted in bilateral lower lobes.
• Nonproductive cough noted.
• Dyspnea with respiratory rate 30/min.
• Oxygen at 2 L/min applied per nasal cannula.
• Telemetry applied: Sinus rhythm at rate 116/min. Abdomen soft, nontender.
• Bowel sounds positive in all 4 quadrants. Lower extremities with 2+ edema noted.
• Pedal pulses palpable bilaterally.
• Peripheral saline lock intact to right forearm with no signs and symptoms of infection.
• Weight 26 kg (44 lb). Increase in dyspnea noted with orthopnea.
• Nasal flaring with respiratory rate of 36/min.
• Lung sounds with wheezing noted throughout.
• Lower extremity edema 3+ to bilateral lower extremities.
• Extremities cool with decreased skin pigmentation noted.
• Peripheral pulses weak bilaterally.
• Jugular vein distention noted.
• Provider notified.

Received prescription for additional dose of furosemide. The client is at risk for developing:

A nurse is planning nutritional teaching for a client who is experiencing fatigue due to iron deficiency anemia.

Which of the following foods should the nurse recommend to the client?

A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD). The client tells the nurse, “I can feel the congestion in my lungs, and I certainly cough a lot, but I can’t seem to bring anything up.”

Which of the following actions should the nurse take to help this client?

A nurse is caring for a client who is receiving cisplatin for treatment of ovarian cancer. The client’s most recent complete blood count (CBC) is shown in the table below.

It is important for the nurse to consider which of the following for the client?

A nurse in the post-anesthesia care unit is caring for a client who is postoperative following a thoracotomy and lobectomy.

Which of the following postoperative assessments should the nurse give highest priority to?

A nurse is providing teaching about iron deficiency anemia to the parents of a toddler.

Which of the following should the nurse recommend as a method of preventing iron deficiency anemia?

A nurse is admitting a client who has active tuberculosis to a room on a medical-surgical unit. Which of the following room assignments should the nurse make for the client?