A nurse is caring for a client who is postpartum and experiencing hypovolemic shock.
Which of the following findings should the nurse expect?
Cool, clammy skin.
Urinary output 30 mL/hr.
Bounding pulses.
Respiratory rate 18/min.
The Correct Answer is A
A client who is postpartum and experiencing hypovolemic shock would have cool, clammy skin.
This is because hypovolemic shock severely limits the body’s ability to get blood
to all of its organs.
Choice B is not correct because a urinary output of 30 mL/hr is within the
normal range.
Choice C is not correct because a client experiencing hypovolemic shock would have a weak pulse, not a bounding one.
Choice D is not correct because a respiratory rate of 18/min is within the normal range, while a client experiencing hypovolemic shock would have an increased respiratory rate.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
“Use an automatic puncture device on the heel.” This is the most common and minimally invasive method to draw capillary blood from an infant for medical testing.
Choice A is incorrect because the heel should be punctured on the outer aspect of the foot to avoid damaging the calcaneus bone.
Choice C is incorrect because the heel should be cleansed with an alcohol swab
before, not after, the procedure.
Choice D is incorrect because there is no need to place an ice pack on the newborn’s heel before the procedure.
Correct Answer is B
Explanation
Nägele’s Rule is a method for estimating the expected date of delivery (EDD) or confinement (EDC).
It involves adding seven days and one year, and subtracting three months, from the first day of the last menstrual period (LMP)1.
Using this rule, if the first day of the client’s last menstrual period was July 28th, then adding seven days would be August 4th.
Subtracting three months would be May 4th.
Adding one year would be May 4th of the following year.
Therefore, the nurse should document May 5th as the client’s expected delivery date.
Choice A is incorrect because April 21st is too early according to Nägele’s Rule calculation.
Choice C is incorrect because May 21st is too late according to Nägele’s Rule calculation.
Choice D is incorrect because April 4th is too early according to Nägele’s Rule calculation.
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