The nurse recognizes that the client is manifesting early signs of hypoxia when the assessment data includes:
restlessness, confusion, tachycardia.
bradycardia, dyspnea, cyanosis.
hypotension, vomiting, cyanosis.
bradycardia, lethargy, confusion.
The Correct Answer is A
Choice A rationale: Restlessness, confusion, and tachycardia are early signs of hypoxia, indicating inadequate oxygenation.
Choice B rationale: Bradycardia, dyspnea, and cyanosis are more indicative of advanced hypoxia.
Choice C rationale: Hypotension, vomiting, and cyanosis may suggest severe hypoxia or other medical issues but are not typically early signs.
Choice D rationale: Bradycardia, lethargy, and confusion are not typical early signs of hypoxia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale: Ineffective gas exchange is related to respiratory issues but may not be the priority in this case.
Choice B rationale: Ineffective breathing pattern is the priority problem, as evidenced by shallow respirations and reluctance to perform coughing and deep breathing, which can lead to respiratory complications.
Choice C rationale: Activity intolerance is not the priority problem based on the given data.
Choice D rationale: Decreased cardiac function is not the priority problem based on the given data.
Correct Answer is D
Explanation
Choice A rationale: Norming is characterized by the development of group cohesion and establishment of norms, not necessarily high-level problem-solving.
Choice B rationale: Storming is marked by conflict and tension within the group, not optimal problem-solving.
Choice C rationale: Forming is the initial stage where members get to know each other; it does not represent a highly functioning team.
Choice D rationale: Performing is the stage where the group is functioning at its highest level, demonstrating effective problem-solving and productivity.
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