A nurse is caring for a client who has just returned from surgery with an external fixator to the left tibia.Which of the following assessment findings requires immediate intervention by the nurse?A. The client's capillary refill in the left toe is 6 seconds.B. The client reports a pain level of 7 on a scale from 0 to 10 at the operative site.C. The client has an oral temperature of 38.3° C (100.9° F).D. The client has 100 mL of blood in the closed-suction drain.

The nurse is caring for a client who had open reduction and internal fixation (OR + IF) of the right femur four days ago. The client complains of intense pain, swelling, tenderness and warmth at the site, chills, malaise, and has a temperature of 39 0C. This data indicates which of the following?

The nurse is caring for a client who is six hours post-partum. The client informs the nurse that they have changed their peri-pad four times in the last six hours. The nurse should take which action?A. Document the finding as expectedB. Massage the client's fundusC. Assess the client for hemorrhageD. Ambulate the client to the bathroom

A nurse in an emergency department is preparing a client for emergency surgery.The client's blood alcohol level is 180 mg/dL.Which of the following actions is the nurse's priority?A. Insert an indwelling urinary catheter.B. Insert an NG tube.C. Obtain consent for surgery.D. Apply antiembolic stockings.

After receiving change-of-shift report, which client does the RN assess first?*1 pointa. A client with nausea and vomiting who complains of abdominal crampsb. A client with a nasogastric (NG) tube who has dry oral mucosa and is complaining of thirstc. A client receiving intravenous (IV) diuretics whose blood pressure is 88/52 mm Hgd. A client with normal saline infusing at 150 mL/hr whose hourly urine output has been averaging 75 mL

A nurse is preparing to assist with the insertion of a non-tunneled central venous catheter for a client who is malnourished. Which of the following actions should the nurse plan to take?