A nurse is assessing a client who has hypoxemia for a late sign. Which finding should the nurse expect?
Hypertension
Tachycardia
Pallor
Bradypnea
The Correct Answer is C
A: Hypertension is not typically a late sign of hypoxemia. It can occur in various conditions but is not specific to hypoxemia.
B: Tachycardia is an early sign of hypoxemia as the body attempts to compensate for low oxygen levels by increasing the heart rate.
C: Pallor is a late sign of hypoxemia. It indicates poor oxygenation and perfusion, often seen when the body can no longer compensate for the lack of oxygen.
D: Bradypnea, or slow breathing, is not a typical sign of hypoxemia. Hypoxemia usually causes an increase in respiratory rate (tachypnea) as the body tries to take in more oxygen.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A: Identifying the type of sedative is important for treatment but is not the immediate priority.
B: Inserting a large-bore IV catheter is necessary for administering medications and fluids but is not the first priority.
C: Ensuring an adequate airway is the priority action. Maintaining airway patency is crucial to prevent respiratory complications and ensure the client receives adequate oxygen.
D: Preparing the appropriate antagonist is important but should follow the immediate action of ensuring an adequate airway.
Correct Answer is B
Explanation
A: Pulling the auricle upward and outward is the correct technique for adults and children over 3 years old, not for a 2-year-old child.
B: Pulling the auricle down and back is the correct technique for straightening the ear canal in children under 3 years old. This allows for proper administration of the eardrops.
C: Sitting the child up to insert a cotton ball into the innermost ear canal is not appropriate. Cotton balls should not be inserted deeply into the ear canal.
D: Sitting the child up for 2 to 3 minutes after instilling drops is not necessary. The child should remain in a position that allows the drops to stay in the ear canal for the prescribed time.
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