A nurse is discussing early signs of hypervolemia with a patient admitted with congestive heart failure. Which signs should the nurse include in their teaching?
Increased thirst and dry mucous membranes
Low blood pressure and increased heart rate
Difficulty breathing and weight gain
Dry cough and poor skin turgor
The Correct Answer is C
Choice A reason: This is not a correct sign of hypervolemia. Increased thirst and dry mucous membranes are signs of dehydration or fluid volume deficit, which can occur due to excessive fluid loss or inadequate fluid intake.
Choice B reason: This is not a correct sign of hypervolemia. Low blood pressure and increased heart rate are signs of hypovolemic shock, which can occur due to severe fluid loss or hemorrhage.
Choice C reason: This is a correct sign of hypervolemia. Difficulty breathing and weight gain are signs of fluid overload, which can occur due to excessive fluid retention or impaired cardiac function. Difficulty breathing can be caused by pulmonary edema, which is the accumulation of fluid in the lungs. Weight gain can be caused by the increase in total body fluid.
Choice D reason: This is not a correct sign of hypervolemia. Dry cough and poor skin turgor are signs of dehydration or fluid volume deficit, which can occur due to excessive fluid loss or inadequate fluid intake.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Decreased heart rate is not a manifestation of hypovolemia. Hypovolemia is a condition where there is a decreased volume of blood in the body, which can result from blood loss, dehydration, or fluid shifts. Hypovolemia can cause the heart rate to increase, not decrease, as the body tries to compensate for the low blood pressure and maintain adequate perfusion.
Choice B reason: Increased blood pressure is not a manifestation of hypovolemia. Hypovolemia can cause the blood pressure to decrease, not increase, as the blood volume and cardiac output are reduced. The body may try to constrict the blood vessels to increase the blood pressure, but this is usually not enough to overcome the effects of hypovolemia.
Choice C reason: Weak pulse is a manifestation of hypovolemia. Hypovolemia can cause the pulse to become weak, thready, or difficult to palpate, as the blood flow and pressure are diminished. The pulse may also become irregular or rapid, as the heart tries to pump faster and harder to deliver oxygen to the tissues.
Choice D reason: Dyspnea is not a specific manifestation of hypovolemia. Dyspnea is a term for difficulty breathing, which can have many causes, such as asthma, pneumonia, or pulmonary edema. Hypovolemia can cause dyspnea if it leads to shock, which is a life-threatening condition where the organs and tissues are not receiving enough oxygen. However, dyspnea alone is not enough to indicate hypovolemia.
Correct Answer is B
Explanation
Choice A reason: Gastritis is not the most likely condition that these clinical manifestations indicate. Gastritis is an inflammation of the stomach lining, which can cause abdominal pain, nausea, vomiting, and loss of appetite. Gastritis may cause heartburn or dyspepsia, but it does not usually cause dysphagia, which is difficulty swallowing.
Choice B reason: GERD is the most likely condition that these clinical manifestations indicate. GERD stands for gastroesophageal reflux disease, which is a chronic condition where the stomach acid flows back into the esophagus, causing irritation and inflammation. GERD can cause heartburn, which is a burning sensation in the chest or throat, dysphagia, which is difficulty swallowing or a feeling of a lump in the throat, and dyspepsia, which is indigestion or discomfort in the upper abdomen.
Choice C reason: Peptic ulcer disease is not the most likely condition that these clinical manifestations indicate. Peptic ulcer disease is a condition where there are open sores or ulcers in the lining of the stomach or duodenum, which can cause bleeding, perforation, or obstruction. Peptic ulcer disease can cause dyspepsia, which is indigestion or discomfort in the upper abdomen, but it does not usually cause heartburn or dysphagia, which are more characteristic of GERD.
Choice D reason: Pancreatitis is not the most likely condition that these clinical manifestations indicate. Pancreatitis is an inflammation of the pancreas, which can cause severe abdominal pain, nausea, vomiting, fever, and jaundice. Pancreatitis does not cause heartburn, dysphagia, or dyspepsia, which are more characteristic of GERD.
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