A nurse is caring for a client who is 3 hr postoperative. Which of the following findings should the nurse understand is a manifestation of bleeding?
Hypertension
2+ edema
Crackles in lungs
Tachycardia
The Correct Answer is D
D. Increased heart rate (tachycardia) is a common manifestation of bleeding. The body compensates for blood loss by increasing the heart rate to maintain blood flow to vital organs
A. Typically, bleeding would cause a decrease in blood pressure rather than hypertension. High blood pressure could indicate other issues like pain or anxiety
B. Edema is not typically a direct manifestation of bleeding. It could indicate fluid overload, a common complication post-surgery, but not necessarily indicative of bleeding.
C. Crackles in lungs could suggest fluid overload or pulmonary edema but not related to bleeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B. Painless vaginal bleeding, especially after sexual intercourse or between menstrual periods, can be an early sign of cervical cancer. This bleeding may occur due to cervical lesions or abnormalities, such as cervical dysplasia or cervical cancer. It is important for individuals to report any abnormal vaginal bleeding to their healthcare provider for further evaluation.
A. Urinary hesitancy, which is difficulty starting urination or a delay in the initiation of the urinary stream, is not typically associated with cervical cancer.
C. Unexplained weight gain is not typically associated with cervical cancer.
D. Frequent diarrhea is not typically associated with cervical cancer.
Correct Answer is C
Explanation
A. Monitoring of vital signs should be more frequent
B. This is an important infection control measure for immunocompromised clients. However, this is more about environmental control and may not directly address the specific isolation protocols regarding direct person-to-person transmission.
C. Wearing an N95 respirator may be recommended for direct care, especially if there is concern about exposure to airborne infections from the environment, staff, or visitors.
D. While disposable plates and utensils are generally preferred for infection control, this is not a specific intervention for protective isolation.
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