A nurse is caring for a patient who is at risk for shock. Which of the following findings is the earliest indicator that this complication is developing?
Hypotension
Narrowing pulse pressure
Decreased level of consciousness
Anuria
The Correct Answer is B
Narrowing pulse pressure is an early indicator that shock is developing 1. Pulse pressure is the difference between systolic and diastolic blood pressure. As shock progresses, the pulse pressure narrows due to a decrease in systolic blood pressure and an increase in diastolic blood pressure.
Choice A is not an answer because hypotension is a later sign of shock 2.
Choice C is not an answer because a decreased level of consciousness is also a later sign of shock.
Choice D is not an answer because anuria, or the absence of urine production, is also a later sign of shock
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
If a client reports acute anxiety, the nurse's first priority should be to remain with the client. The nurse should provide a safe, supportive environment for the client and help the client feel less anxious. This can be accomplished by staying with the client, listening attentively to the client, and offering reassurance and support. Options A and D are appropriate actions to take when caring for a client with anxiety, but they are not the first priority.
Option B may be an appropriate intervention when caring for a client with anxiety, but it is not the first priority.
Correct Answer is C
Explanation
choice C, "I have heard that abusers think of themselves as important and have high self-esteem." This statement is incorrect and shows the nurse may need further education on the characteristics of an abuser. Abusers often lack self-esteem and feel powerless, using abuse as a way to gain control and confidence. Choices A, B, and D are all accurate statements and do not indicate the need for further education.
For choice A, abusers often isolate their partner to gain control over them. For choice B, abusers may lack social support and social skills, leading to violent behavior.
For choice D, abusers use intimidation tactics to maintain power in the relationship.
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