A nurse is assessing a client who is postoperative and has anemia due to excess blood loss following surgery. Which of the following findings should the nurse expect?
Hypertension
Diarrhea
Fatigue
Bradycardia
The Correct Answer is C
A. Hypertension: Anemia is more likely to be associated with hypotension rather than hypertension. The body often responds to anemia by increasing heart rate and cardiac output to compensate for reduced oxygen-carrying capacity.
B. Diarrhea: Anemia itself is not directly associated with diarrhea. Excess blood loss can lead to anemia, but diarrhea is not a typical manifestation of anemia.
C. Fatigue: This is the correct answer. Fatigue is a common symptom of anemia, as reduced oxygen delivery to tissues can lead to feelings of weakness, tiredness, and lack of energy.
D. Bradycardia: Anemia is more likely to be associated with compensatory tachycardia (increased heart rate) rather than bradycardia. The body attempts to maintain oxygen delivery to tissues by increasing cardiac output.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Maintaining a semi-Fowler's position as often as possible: While maintaining an elevated position can assist with breathing, it may not directly address the issue of tenacious bronchial secretions. Adequate hydration and other measures are often more effective.
B. Encouraging the client to drink 2 to 3 L of water daily: This is the correct answer. Adequate hydration helps to thin mucus, making it easier to clear from the airways. Drinking 2 to 3 liters of water daily is a helpful strategy to promote hydration and reduce the viscosity of bronchial secretions.
C. Helping the client select a low-salt diet: While a low-salt diet may have cardiovascular benefits, it is not a primary intervention for addressing tenacious bronchial secretions. Hydration and airway clearance techniques are more directly relevant.
D. Administering oxygen via nasal cannula at 2 L/min: While oxygen therapy may be necessary in COPD, it is not the primary intervention for managing tenacious bronchial secretions. Hydration and other measures aimed at thinning mucus are more appropriate.
Correct Answer is D
Explanation
A. A friction rub:A friction rub is a sound caused by the rubbing of inflamed pericardial layers and is not classified as a heart sound like S1 or S2. It is unrelated to the sequence of heart sounds.
B. A split second heart sound S₂:A split S₂ occurs during the closure of the aortic and pulmonary valves and is heard after S1, not before.
C. The third heart sound (S3):S3, or the ventricular gallop, occurs shortly after S2 during early diastole and indicates rapid ventricular filling. It is not heard before S1.
D. The fourth heart sound (S4):S4, known as the "atrial gallop," occurs just before S1 during atrial contraction. It is associated with a stiff or hypertrophied ventricle and is often indicative of underlying heart disease, especially in older adults.
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