A nurse is caring for a client who returns to the nursing unit from the recovery room after a sigmoid colon resection for adenocarcinoma. The client had an episode of intraoperative bleeding. Which finding indicates to the nurse that the client may be developing hypovolemic shock?

Decrease in the urinary output from 50 mL to 30 mL per hour.

Increase in the heart rate from 88 to 110/min.

Decrease in the respiratory rate from 20 to 16/min.

Increase in the temperature from 37.5° C (99.5° F) to 38.6° C (101.5° F).

Answer and Explanation

The Correct Answer is B

A. A decrease in urinary output can be a sign of decreased blood volume but is less immediate than changes in heart rate.
B. An increase in the heart rate is a common compensatory response to hypovolemia as the body attempts to maintain adequate perfusion to vital organs.
C. A decrease in the respiratory rate is not typically associated with hypovolemic shock; rather, respiratory rate may increase due to compensatory mechanisms.
D. An increase in temperature is not a specific indicator of hypovolemic shock; it could be related to infection or inflammation rather than immediate hypovolemia.

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Correct Answer is A

Explanation

A. Regular insulin is used in the treatment of diabetic ketoacidosis (DKA) due to its rapid onset and ability to lower blood glucose levels quickly. It is administered intravenously for immediate effect.
B. NPH insulin is an intermediate-acting insulin and is not appropriate for the rapid correction needed in DKA.
C. Insulin detemir is a long-acting insulin used for basal insulin control, not suitable for acute DKA treatment.
D. Insulin glargine is a long-acting insulin, which would not be used in the acute setting of DKA where rapid control of blood glucose is required.

A. Inverted P wave B. Elevated ST segment C. Abnormally prominent U wave D. Wide QRS

Correct Answer is C

Explanation

A. An inverted P wave is not a classic sign of hypokalemia. It can occur due to various other reasons, including atrial abnormalities.

B. An elevated ST segment is more indicative of hyperkalemia or ischemic changes rather than hypokalemia.

C. An abnormally prominent U wave is a common sign of hypokalemia. Hypokalemia can cause changes in the EKG, including the presence of a prominent U wave following the T wave.

D. A wide QRS complex is typically associated with hyperkalemia or bundle branch blocks, not hypokalemia.

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A nurse is caring for a client who returns to the nursing unit from the recovery room after a sigmoid colon resection for adenocarcinoma. The client had an episode of intraoperative bleeding. Which finding indicates to the nurse that the client may be developing hypovolemic shock?

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Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A nurse is reviewing the EKG strip of a client who has prolonged vomiting. Which of the following abnormalities on the client's EKG should the nurse interpret as a sign of hypokalemia?

Correct Answer is C

Explanation

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