A nurse is attending to a client experiencing hypovolemic shock.
What findings should the nurse anticipate?
Hypertension
Purpura
Bradypnea
Oliguria
The Correct Answer is D
Choice A rationale
Hypertension is not typically associated with hypovolemic shock. In fact, hypotension, or low blood pressure, is more common.
Choice B rationale
Purpura, or blood spots, are not typically associated with hypovolemic shock.
Choice C rationale
Bradypnea, or slow breathing, is not typically associated with hypovolemic shock. Rapid, shallow breathing is more common.
Choice D rationale
Oliguria, or decreased urine output, is a common finding in hypovolemic shock. It occurs due to decreased blood flow to the kidneys.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Alendronate should be taken at least 30 minutes before the first food, beverage, or medication of the day with plain water only. This is because other beverages (including mineral water), food, and some medications are likely to reduce the absorption of alendronate.
Choice B rationale
Alendronate should not be taken with milk. This is because the calcium in the milk can bind to the alendronate, preventing it from being absorbed into the body and therefore making it less effective. This is why the patient’s statement indicates a need for further instruction.
Choice C rationale
After taking alendronate, the patient should not lie down and should remain fully upright (sitting, standing, or walking) for at least 30 minutes. This is to help alendronate reach the stomach more quickly and also to reduce the risk of irritation to the esophagus. Therefore, sitting up and reading the morning paper after taking alendronate is a correct practice.
Choice D rationale
Regular bone density tests are necessary while taking alendronate. This is to monitor the drug’s effectiveness in increasing bone mass and to adjust the treatment plan as necessary. Therefore, the patient’s statement is correct.
Correct Answer is D
Explanation
Choice A rationale
Assisting the client to sit upright in a chair for 4 hr at a time is not recommended postoperatively following spinal fusion. This could put undue stress on the surgical site and potentially lead to complications.
Choice B rationale
Expecting clear drainage on the spinal dressing is not accurate. Any drainage from the surgical site should be closely monitored for signs of infection, but clear drainage is not typically expected.
Choice C rationale
Elevating the client’s legs when he is lying on his side is not a specific intervention related to postoperative care following spinal fusion.
Choice D rationale
Log rolling the client every 2 hr is the correct intervention. This technique is used to maintain proper alignment and prevent undue stress on the surgical site.
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