Adult health / medical-surgical nursing · practice question
A 59-year-old client in the intensive care unit is being evaluated for rapidly worsening vital signs. Assessment data include urine output 15 mL/hr for 2 hours with rising creatinine. Which assessment approach should the nurse use first?
Multiple choiceHardnclex-rn-bsnnclex-validatednclex-2026adult-health-med-surg
Answer and explanation
Correct answer
A. Screen for instability, then perform a focused assessment related to the presenting concern.
Why
Assessment begins with stability screening and focused data collection before invasive or delayed actions.
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