A nurse in a community clinic is collecting data from a client who reports frequent vomiting and diarrhea for the past 3 days. Which of the following findings should the nurse expect? (Select all that apply.)

(Select All that Apply.)

Bradycardia

Pale Yellow Urine

Poor Skin Turgor

Hypotension

Flat Neck Veins

Answer and Explanation

Correct Answer : C,D,E

A. Bradycardia: Vomiting and diarrhea usually lead to tachycardia (increased heart rate) as the body compensates for hypovolemia, not bradycardia (slow heart rate).

B. Pale Yellow Urine: Dehydration often causes the urine to become concentrated and dark yellow, not pale yellow.

C. Poor Skin Turgor: Poor skin turgor is a classic sign of dehydration caused by fluid loss.

D. Hypotension: Loss of fluid volume can result in hypotension due to reduced blood circulation.

E. Flat Neck Veins: Dehydration causes reduced venous return, leading to flat neck veins, particularly when lying down.

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Correct Answer is A

Explanation

A. Upright: Sitting upright promotes optimal lung expansion by reducing pressure on the diaphragm and improving ventilation.

B. Side-lying: This may be used for comfort but does not maximize lung expansion.

C. Supine: Lying flat can compromise lung expansion, particularly in respiratory distress.

D. Prone: While prone positioning is used in specific cases of severe respiratory failure (e.g., ARDS), it is not standard for general pneumonia in children.

A. The nurse applies a tourniquet to assess a vein. B. The nurse dons gloves before starting the IV. C. The nurse blows on the area cleansed with alcohol to dry it quickly D. The nurse cleans the area with an alcohol pad

Correct Answer is C

Explanation

A. The nurse applies a tourniquet to assess a vein: Applying a tourniquet is standard practice and does not increase infection risk if proper technique is used.

B. The nurse dons gloves before starting the IV: Wearing gloves minimizes the risk of infection for both the patient and the nurse.

C. The nurse blows on the area cleansed with alcohol to dry it quickly: Blowing on the site introduces bacteria from the nurse's breath to the cleansed area, increasing the risk of infection.

D. The nurse cleans the area with an alcohol pad: Cleaning the site with alcohol reduces the risk of infection and is standard practice.

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A nurse in a community clinic is collecting data from a client who reports frequent vomiting and diarrhea for the past 3 days. Which of the following findings should the nurse expect? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

A nurse is assisting with the care of a school-age child who has respiratory failure due to pneumonia. Which of the following positions should the nurse encourage to allow maximal lung expansion?

Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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