While caring for a client with anemia, the nurse notes increasing fatigue and pale skin. What should the nurse do first?
Pallor and fatigue may indicate decreased oxygen-carrying capacity. Checking vital signs helps determine severity and whether additional intervention is required.
During wound care, the nurse notices yellow drainage. What should the nurse do first?
Yellow drainage may indicate infection. Assessing and documenting characteristics helps determine next steps.
A client receiving antibiotics develops watery diarrhea. What should the nurse do first?
Antibiotic-associated diarrhea may indicate C. difficile infection. Reporting promptly ensures proper isolation and testing.
A client receiving IV fluids complains of swelling and pain at the IV site. What should the nurse do first?
Swelling and pain suggest infiltration. Stopping the IV prevents further tissue damage from fluid leakage.
The nurse is reinforcing teaching for a client starting iron supplements. Which statement shows understanding?
Iron can cause dark stools and constipation. Taking it with vitamin C improves absorption.
A client with hypertension states they stopped taking their medication because they felt fine. What is the nurseu2019s best response?
Hypertension can be asymptomatic, and stopping medication increases risk of complications. Reinforcing adherence helps prevent serious outcomes.
A client with a urinary tract infection reports burning during urination. What should the nurse encourage?
Increasing fluid intake helps flush bacteria from the urinary tract and reduce symptoms.
A client with dehydration is receiving IV fluids. Which finding indicates improvement?
Moist mucous membranes signal improved hydration and fluid balance.
A client with asthma begins to wheeze after activity. What is the nurseu2019s priority action?
Wheezing indicates airway narrowing. A short-acting bronchodilator provides fast relief.