A nurse is caring for a client who is postoperative and has developed atelectasis.
Which of the following findings should the nurse expect?
Facial flushing.
Dry cough.
Decreasing respiratory rate.
Increasing dyspnea.
The Correct Answer is D
Choice A rationale:
Facial flushing. Facial flushing is not typically associated with atelectasis. Atelectasis is the collapse of a portion of the lung, which can lead to decreased oxygenation and respiratory distress but does not directly cause facial flushing. Flushing may be related to other factors such as fever or allergic reactions.
Choice B rationale:
Dry cough. A dry cough can be a common symptom of atelectasis. As the lung tissue collapses and airways become obstructed, it can lead to irritation and a dry, non-productive cough as the body attempts to clear the airway. So, a dry cough is an expected finding in a client with atelectasis.
Choice C rationale:
Decreasing respiratory rate. A decreasing respiratory rate is not typically associated with atelectasis. In fact, atelectasis often leads to an increased respiratory rate as the body tries to compensate for the reduced oxygen exchange. The patient may experience tachypnea (rapid breathing) as a result.
Choice D rationale:
Increasing dyspnea. Increasing dyspnea is a common and expected finding in a client with atelectasis. As lung tissue collapses and oxygen exchange is compromised, the patient will likely experience worsening shortness of breath. This is a concerning symptom and should be closely monitored, as it may indicate a need for intervention to improve lung expansion and oxygenation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Hypovolemic shock is characterized by a decrease in blood volume, leading to low blood pressure and compensatory mechanisms such as a high pulse rate. When the body experiences a significant loss of blood or fluid, it attempts to maintain perfusion to vital organs by increasing the heart rate to ensure an adequate blood supply. Low blood pressure and a high pulse rate are classic signs of hypovolemic shock.
Choice B rationale:
A low BP and low pulse rate are not indicative of hypovolemic shock. Hypovolemic shock is associated with a rapid and weak pulse rate as the body tries to compensate for decreased blood volume. A low pulse rate could suggest other conditions, such as bradycardia, rather than hypovolemic shock.
Choice C rationale:
High BP and high pulse rate are not typical findings in hypovolemic shock. Hypovolemic shock is characterized by low blood pressure and a high pulse rate as the body attempts to compensate for the reduced blood volume. High blood pressure is more commonly associated with conditions like hypertension, not hypovolemic shock.
Choice D rationale:
High BP and low pulse rate are not consistent with the characteristics of hypovolemic shock. As mentioned earlier, hypovolemic shock is marked by low blood pressure and a high pulse rate due to the body's efforts to maintain adequate perfusion. High blood pressure and a low pulse rate may suggest other medical conditions unrelated to hypovolemic shock.
Correct Answer is B
Explanation
Choice A rationale:
Hypoglycemia Hypokalemia (low potassium levels) is not typically associated with hypoglycemia (low blood sugar). Hypokalemia primarily affects the function of muscles and nerves, and it does not directly influence blood glucose levels.
Choice B rationale:
Cardiac dysrhythmias Hypokalemia can lead to cardiac dysrhythmias. Potassium plays a crucial role in maintaining the electrical activity of the heart, and low potassium levels can disrupt normal cardiac rhythms, potentially leading to life-threatening arrhythmias. Cardiac dysrhythmias are a well-recognized complication of severe hypokalemia, making this choice the correct one.
Choice C rationale:
Increased appetite Hypokalemia is not associated with an increased appetite. In fact, it can lead to gastrointestinal disturbances, such as nausea, vomiting, and abdominal pain, which may decrease appetite. The primary manifestations of hypokalemia are related to muscle weakness and cardiac abnormalities.
Choice D rationale:
Hyperreflexia Hyperreflexia (excessive reflex responses) is not a typical manifestation of hypokalemia. Hypokalemia is more commonly associated with muscle weakness, cramps, and cardiac disturbances. Hyperreflexia is often seen in conditions of excessive calcium levels (hypercalcemia) or neurological disorders, not hypokalemia.
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