A nurse is assessing a client who has hypothermia. Which of the following findings should the nurse identify as a manifestation of hypothermia?

Impaired coordination

Sensitivity to light

Increased respiratory rate

Hypertension

Answer and Explanation

The Correct Answer is A

A) Impaired coordination:
Impaired coordination is a common manifestation of hypothermia. As the body temperature drops, the nervous system is affected, leading to difficulties in motor control and coordination. This symptom is indicative of the body's struggle to maintain normal physiological functions in response to the cold.

B) Sensitivity to light:
Sensitivity to light is not typically associated with hypothermia. This symptom is more commonly related to conditions affecting the eyes or the central nervous system, such as migraines or meningitis.

C) Increased respiratory rate:
Hypothermia generally leads to a decreased respiratory rate as the body's metabolic processes slow down. An increased respiratory rate is not a common symptom and may indicate another underlying condition or a compensatory mechanism for another issue.

D) Hypertension:
Hypertension is not a typical manifestation of hypothermia. In fact, as hypothermia progresses, the body's blood pressure often decreases due to reduced cardiac output and peripheral vasoconstriction.

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Correct Answer is C

Explanation

A) Decreased systolic blood pressure: In older adults, systolic blood pressure often increases due to stiffening of the arteries rather than decreasing. This increase in systolic blood pressure is due to reduced elasticity in blood vessels, making it a common physiological change.

B) Decreased anteroposterior chest diameter: In fact, the anteroposterior chest diameter often increases with age due to changes in the rib cage and spine, such as kyphosis. An increased chest diameter is observed in older adults, not a decrease.

C) Increased cerumen thickness: As people age, cerumen (earwax) production can increase and the cerumen can become thicker and drier. This is due to changes in the ceruminous glands and can lead to more frequent earwax impaction in older adults, making it a relevant point to include in the educational program.

D) Increased saliva production: Typically, older adults experience a decrease in saliva production, not an increase. Reduced saliva production can contribute to difficulties with chewing, swallowing, and oral health.

A. Administer a dose of subcutaneous epinephrine. B. Advise the client not to consume grapefruit products. C. Place warm compresses on both sides of the client's face. D. Swab the client's oral mucosa with nystatin suspension.

Correct Answer is A

Explanation

A. Administer a dose of subcutaneous epinephrine.: The swelling of the lips and tongue is indicative of angioedema, a serious adverse reaction to captopril. Epinephrine is the first-line treatment for severe allergic reactions or angioedema to quickly counteract the swelling and prevent airway obstruction.

B. Advise the client not to consume grapefruit products.: Grapefruit can interact with some medications, but it is not related to the management of angioedema. This action would be more relevant for drugs metabolized by CYP3A4, not specifically for angioedema.

C. Place warm compresses on both sides of the client's face.: Warm compresses are not appropriate for angioedema and may not address the underlying issue. This action does not manage the immediate, potentially life-threatening reaction caused by captopril.

D. Swab the client's oral mucosa with nystatin suspension.: Nystatin is used for fungal infections of the oral mucosa, not for angioedema. This action does not address the adverse reaction related to captopril.

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A nurse is assessing a client who has hypothermia. Which of the following findings should the nurse identify as a manifestation of hypothermia?

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Naxlex Comprehensive Predictor Exams

A charge nurse in a long-term care facility is developing an educational program for staff members about common physiological changes in older adults. Which of the following information should the nurse include?

Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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