The nurse is assessing a client with esophageal varices. Which of these findings would be early indicators of bleeding?

Epigastric fullness and increasing combativeness

Yellow sclera, hypertension, and hypoalbuminemia

Bradycardia, lethargy, and hypotension

Tachycardia, restlessness, and pallor

Answer and Explanation

The Correct Answer is D

Choice A reason: Epigastric fullness may suggest variceal pressure, but combativeness isn’t typical early bleeding; it’s more neurological, not a direct blood loss sign.

Choice B reason: Yellow sclera and hypoalbuminemia reflect liver dysfunction, not acute bleeding; hypertension contradicts blood loss, which lowers pressure initially.

Choice C reason: Bradycardia and lethargy occur late in severe hypovolemia, not early; hypotension fits bleeding but isn’t paired with early compensatory signs here.

Choice D reason: Tachycardia compensates for early blood loss in varices, restlessness reflects hypoxia, and pallor shows reduced perfusion, all classic initial bleeding indicators.

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Correct Answer is D

Explanation

Choice A reason: Increasing oxygen to 3 L/min may help but risks CO2 retention in COPD without assessing respiratory rate, depth, and saturation first, making it premature.

Choice B reason: Coughing clears secretions, but without assessing respiratory status, it’s unclear if secretions are the issue or if the client can effectively cough, so it’s not priority.

Choice C reason: Calling emergency services assumes severity without data like oxygen saturation or distress level, delaying care by skipping initial assessment in this stable setting.

Choice D reason: Assessing respiratory status (rate, oxygen saturation, lung sounds) identifies the cause of difficulty, guiding interventions like oxygen adjustment or escalation, per ABC priority.

A. Emphysema B. Peripheral vascular disease C. Heart failure D. Bronchitis

Correct Answer is D

Explanation

Choice A reason: Emphysema destroys alveoli, causing air trapping and dyspnea, but doesn’t involve excessive mucus production, focusing on structural loss, not glandular activity.

Choice B reason: Peripheral vascular disease impairs arterial flow, causing ischemia and pain, not affecting airways or mucus glands, unrelated to respiratory secretions.

Choice C reason: Heart failure leads to fluid in alveoli (edema), causing crackles, but not excessive mucus, as it’s a circulatory, not inflammatory airway issue.

Choice D reason: Bronchitis inflames bronchial tubes, overactivating goblet cells to produce excess mucus, leading to productive cough, a hallmark of this condition.

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The nurse is assessing a client with esophageal varices. Which of these findings would be early indicators of bleeding?

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