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A nurse is assessing a patient and notes that the patient is experiencing hypoxia.
Which of the following patient signs would indicate that the patient has hypoxia? Select all that apply.

increased respiratory rate

confusion

cyanosis

restlessness

dyspnea

Bradychardia

Hypertension

Nausea and vomiting

Answer and Explanation

Correct Answer : A,B,C,D,E

The correct answer is choices A, B, C, D, and E.

Hypoxia occurs when there is inadequate oxygen supply to the body's tissues. Signs of hypoxia can vary depending on the severity of the condition. The following signs can indicate hypoxia:

Increased respiratory rate - Hypoxia can cause an increased respiratory rate as the body tries to increase oxygen levels in the blood.
Confusion - Hypoxia can affect cognitive function, leading to confusion.
Cyanosis - Hypoxia can cause a blue or purple discoloration of the skin, lips, or nail beds due to the lack of oxygen.
Restlessness - Hypoxia can cause restlessness or agitation.
Dyspnea - Hypoxia can cause difficulty breathing, also known as dyspnea.
Bradycardia - Bradycardia, or a slow heart rate, is not typically a direct sign of hypoxia. Hypoxia often leads to tachycardia (increased heart rate) as the body tries to compensate for low oxygen levels.
Hypotension - While severe hypoxia can eventually lead to changes in blood pressure, hypotension (low blood pressure) is not a primary sign of hypoxia. Typically, hypoxia might cause hypertension or have no immediate impact on blood pressure.
Nausea and Vomiting - While nausea and vomiting can be related to various conditions, they are not specific signs of hypoxia. These symptoms might occur due to other issues or as a secondary effect in some cases, but they are not primary indicators of hypoxia.

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Correct Answer is B

Explanation

A. Skin was pink, warm, dry, and intact. Capillary refill was less than 5 seconds in all fingers. Radial pulses were +4 and equal bilaterally. Grips were strong 10 out of 10 and equal bilaterally:
Incorrect. Capillary refill should be less than 2-3 seconds for normal findings; less than 5 seconds would be too long and could indicate poor perfusion. Radial pulses graded +4 are not typical and suggest a bounding pulse, which could indicate an abnormal condition. Grips graded 10/10 is not the standard grading system; typically, grips are graded out of 5.

B. Skin was pink, warm, dry, and intact. Capillary refill was less than 3 seconds in all fingers. Radial pulses were +2 and equal bilaterally. Grips were strong 5/5 and equal bilaterally:
Correct. This option uses proper terminology. Capillary refill of less than 3 seconds is normal, radial pulses graded +2 are normal, and grips are appropriately graded on a 5-point scale, with 5/5 being the normal strength.

C. Skin was pink, warm, dry, and intact. Capillary refill was more than 3 seconds in all fingers. Radial pulses were 1 and equal. Grips were strong 4/4 and symmetrical:
Incorrect. Capillary refill of more than 3 seconds indicates delayed perfusion, which is abnormal. Radial pulses graded 1 indicate a weak pulse, which is not within normal limits. Additionally, grips are usually graded out of 5, not 4.

D. Skin was warm and dry and intact. Capillary refill was less than 3 seconds in all fingers. Radial pulses were 3. Grips were strong and equal:
Incorrect. While some aspects are correct (capillary refill), the pulse grading system is incomplete here. Radial pulses should be recorded as +1 to +4, and +3 would indicate a stronger-than-normal pulse, which is not typical for normal findings. Grip strength is not fully documented here either, as it should include a scale (e.g., 5/5).

A. Low-calorie dense foods B. High trans fat foods C. High-glycemic index foods D. High-calorie dense foods

Correct Answer is A

Explanation

The correct answer is choice A, low-calorie dense foods. Low-calorie dense foods are those that have fewer calories per unit of volume, such as fruits, vegetables, and lean protein sources. These foods can help the client feel full and satisfied while still consuming fewer calories, which is important for weight loss. High trans fat foods (choice B) and high-glycemic index foods (choice C) should be avoided or limited as they can contribute to weight gain and other health problems. Highcalorie dense foods (choice D) should also be avoided or limited as they can provide too many calories without providing enough nutrients.

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A nurse is assessing a patient and notes that the patient is experiencing hypoxia. Which of the following patient signs would indicate that the patient has hypoxia? Select all that apply.

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A nurse is assessing a patient and notes that the patient is experiencing hypoxia.
Which of the following patient signs would indicate that the patient has hypoxia? Select all that apply.