A nurse in the urgent care facility is assessing a client who reports frequent vomiting and diarrhea for the past 3 days. Which objective findings should the nurse expect? (Select three options that apply.)
Pale yellow urine
Flat neck veins
Hypotension
Poor skin turgor
Bradycardia
Correct Answer : B,C,D
A. Pale yellow urine would not be expected, as dehydration often leads to concentrated, dark urine.
B. Flat neck veins are a sign of dehydration and decreased fluid volume.
C. Hypotension is expected with dehydration due to a drop in circulating blood volume.
D. Poor skin turgor is a common indicator of dehydration as the skin loses elasticity.
E. Bradycardia is not expected; rather, tachycardia is more common in dehydration as the body tries to compensate for fluid loss.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. This is the correct response because it educates the client on the fact that many sore throats are viral in origin and antibiotics, which treat bacterial infections, would not be effective in such cases. Overuse of antibiotics can also contribute to antibiotic resistance.
B. Asking the client to bring the bottle of antibiotics does not address the misuse of the medication.
C. This statement is incorrect as streptococcal infections often involve fever.
D. A throat culture would help confirm the cause of the sore throat, and antibiotics should not be taken without proper diagnosis.
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}
Explanation
Drowsiness can indicate worsening head trauma or other neurological issues, especially following a head injury. Increased drowsiness could be a subtle sign of a more serious condition such as a concussion or even intracranial bleeding. It is critical to assess and manage this symptom first.
After addressing the potential neurological concern, the nurse should then manage the right shoulder pain, which is significant but less immediately life-threatening than the possible neurological changes.
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