A nurse assisting in the collection of data for a client who is in the early compensatory stage of hypovolemic shock.
Which of the following findings should the nurse expect?
Tachycardia.
Diminished urine output.
Cold clammy skin.
Unconsciousness.
The Correct Answer is A
Choice A rationale:
Tachycardia, or a rapid heart rate, is a common early sign of hypovolemic shock as the body tries to compensate for the decreased blood volume by increasing the heart rate.
Choice B rationale:
Diminished urine output is a sign of hypovolemic shock, but it is not typically an early sign.
Choice C rationale:
Cold, clammy skin is a sign of hypovolemic shock, but it is not typically an early sign.
Choice D rationale:
Unconsciousness is a late sign of hypovolemic shock, indicating severe blood loss and inadequate perfusion to the brain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
The medication should be dropped into the conjunctival sac, which is the space between the lower eyelid and the eyeball. This is the correct method for administering ophthalmic drops.
Choice B rationale:
The eyedropper should not touch any part of the eye, including the sclera, to avoid contamination and potential infection.
Choice C rationale:
It is not necessary to don sterile gloves when administering ophthalmic drops. Clean gloves or hand hygiene is sufficient.
Choice D rationale:
Rubbing the eye after instilling medication can cause irritation and may disperse the medication, reducing its effectiveness.
Correct Answer is ["1128"]
Explanation
The correct answer is 1420 mL.
Calculation:
Convert all intake to mL:
- 4 oz soda = 118 mL
- 12 oz water = 355 mL
- 1 cup gelatin = 237 mL
- 1/2 cup broth = 118 mL
- 300 mL IV fluid = 300 mL
Add all intake: 118 mL + 355 mL + 237 mL + 118 mL + 300 mL = 1128 mL
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