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

Answer and Explanation

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.

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Correct Answer is D

Explanation

Albumin is a protein that plays a crucial role in maintaining skin health. Low albumin levels (hypoalbuminemia) can lead to poor wound healing and skin vulnerability.

Hemoglobin level, white cell count and 25-hydroxyvitamin have no direct role in skin breakdown.

A. Avoid getting a flu vaccination. B. Limit fluids to 1.5 L per day. C. Limit alcohol intake to one drink per day. D. Avoid extremely hot or cold temperatures.

Correct Answer is D

Explanation

D. Extreme temperatures, both hot and cold, can trigger sickle cell crises in individuals with sickle cell disease. Cold temperatures can cause vasoconstriction and increase the risk of sickling of red blood cells, while hot temperatures can lead to dehydration. Therefore, clients with sickle cell disease should avoid exposure to extreme temperatures and take precautions to maintain a comfortable environment, especially during hot summer months and cold winter seasons.
A. Clients with sickle cell disease are at increased risk of developing complications from influenza (flu) infections. Therefore, it is highly recommended that clients with sickle cell disease receive an annual flu vaccination to reduce their risk of contracting the flu and its associated complications.
B. Hydration is crucial for individuals with sickle cell disease as it helps prevent dehydration and reduces the risk of sickling of red blood cells, which can trigger a sickle cell crisis.
C. Alcohol can exacerbate dehydration and increase the risk of vaso-occlusive crises in individuals with sickle cell disease.

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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?

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