A nurse is assessing a client who has experienced significant blood loss. Which of the following is a clinical sign of hypovolemia?
Bradycardia
Hypertension
Polyuria
Cool, clammy skin
The Correct Answer is D
A. Bradycardia is not typical in hypovolemia; tachycardia is more common as the body compensates for fluid loss.
B. Hypotension, rather than hypertension, occurs due to reduced blood volume.
C. Polyuria is not a feature of hypovolemia; decreased urine output is expected.
D. Cool, clammy skin is a classic sign of hypovolemic shock as blood flow to the skin decreases in response to blood loss.
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Related Questions
Correct Answer is ["B","D"]
Explanation
A. Monitoring blood glucose levels is not directly related to managing fluid volume excess.
B. Weighing the client daily is essential for monitoring fluid retention and the effectiveness of interventions.
C. Preparing for hemodialysis is only necessary for severe fluid overload unresponsive to other treatments.
D. Restricting sodium in the diet helps prevent further fluid retention and supports management of FVE.
E. Changing IV fluids to D5W is not appropriate, as it could exacerbate fluid volume excess by increasing fluid load.
Correct Answer is D
Explanation
A. Darbepoetin alfa is used to treat anemia, particularly in chronic kidney disease, but does not address hyperkalemia.
B. Lactulose is used to reduce ammonia levels in hepatic encephalopathy, not to lower potassium levels.
C. Sevelamer is a phosphate binder and does not affect potassium levels.
D. Sodium polystyrene (Kayexalate) is used to treat hyperkalemia by promoting potassium excretion through the gastrointestinal tract.
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