A nurse is collecting data from a client who sustained blood loss. Which of the following findings should the nurse identify as a manifestation of hypovolemia?

Increased blood pressure

Thready pulse

Dyspnea

Decreased heart rate

Answer and Explanation

The Correct Answer is B

A. Increased blood pressure: Hypovolemia typically causes a decrease in blood pressure, not an increase.
B. Thready pulse: A thready pulse is a common sign of hypovolemia due to decreased blood volume.
C. Dyspnea: While dyspnea can occur, it is not as specific as a thready pulse for hypovolemia.
D. Decreased heart rate: Hypovolemia usually causes an increased heart rate as the body tries to compensate for low blood volume.

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Correct Answer is B

Explanation

A. Massage the injection site after administration of the medication. Massaging the site after heparin injection can cause bruising and should be avoided.
B. Inject the medication into the abdomen above the level of the iliac crest: This is the recommended site for subcutaneous heparin injections.
C. Use a 1-inch needle to inject the medication. A shorter needle (5/8 inch) is typically used for subcutaneous injections, not a 1-inch needle.
D. Use a 22-gauge needle to inject the medication: A smaller gauge needle (25 to 27 gauge) is typically used for subcutaneous injections, not 22-gauge.

A. Limit fluid intake to 1,000 mL daily. B. Bear down hard when defecating. C. Reduce activity. D. Eat raw vegetables.

Correct Answer is D

Explanation

A. Limit fluid intake to 1,000 mL daily. Increasing fluid intake, not limiting it, helps alleviate constipation.
B. Bear down hard when defecating. Bearing down hard can cause harm, such as hemorrhoids, and does not help relieve constipation.
C. Reduce activity: Increasing physical activity helps promote bowel movements, so reducing activity is not advisable.
D. Eat raw vegetables. Raw vegetables are high in fiber and can help alleviate constipation.

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A nurse is collecting data from a client who sustained blood loss. Which of the following findings should the nurse identify as a manifestation of hypovolemia?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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