A nurse is collecting data on a client who has respiratory alkalosis. Which of the following findings should the nurse expect?
Dry skin
Diarrhea
Hyperventilation
Abdominal pain
The Correct Answer is C
A. Dry skin:
Dry skin is not typically associated with respiratory alkalosis. Instead, it may occur in conditions such as dehydration or impaired skin integrity.
B. Diarrhea:
Diarrhea is not typically associated with respiratory alkalosis. Respiratory alkalosis primarily involves changes in the respiratory system, leading to alterations in blood pH and carbon dioxide levels.
C. Hyperventilation:
Hyperventilation is a characteristic finding in respiratory alkalosis. It is a compensatory mechanism where the client breathes rapidly and deeply to blow off excess carbon dioxide, attempting to restore acid-base balance.
D. Abdominal pain:
Abdominal pain is not typically associated with respiratory alkalosis. While some individuals with respiratory alkalosis may experience symptoms such as dizziness, lightheadedness, or tingling sensations, abdominal pain is not a common manifestation of this acid-base imbalance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) S3 heart sounds:
S3 heart sounds are typically associated with heart failure and are not directly related to premature ventricular contractions (PVCs). S3 heart sounds occur during the early diastolic phase and are heard immediately after S2.
B) Irregular pulsations:
This is the correct choice. Premature ventricular contractions (PVCs) can cause irregular pulsations in the pulse. PVCs are premature contractions originating from the ventricles, which can interrupt the normal rhythm of the heart and lead to irregularities in the pulse.
C) Bradycardia:
Premature ventricular contractions (PVCs) can lead to various rhythm disturbances, but bradycardia (slow heart rate) is not typically associated with PVCs. In fact, PVCs often occur in the context of tachycardia (rapid heart rate).
D) Increase in point of maximum impulse (PMI):
An increase in the point of maximum impulse (PMI) is not typically associated with premature ventricular contractions (PVCs). The PMI refers to the location where the apex of the heart is palpated during systole and is not directly affected by PVCs.
Correct Answer is D
Explanation
A. Helping the client into the shower: This task can be safely delegated to an assistive personnel (AP). The AP can help the client with activities of daily living such as showering, as long as the client is stable and does not require close monitoring.
B. Ambulating the client in the hallway: This task can also be delegated to an AP. Assisting with ambulation is within the scope of practice for an AP, provided the client is stable and there are no specific concerns that require a nurse’s assessment.
C. Measuring vital signs: While measuring vital signs is a critical task, it can be delegated to an AP. The AP can be trained to accurately measure and report vital signs. However, the nurse should review and interpret the results.
D. Removing the sternal dressing: This is the correct answer. Removing a sternal dressing after cardiac surgery is a complex task that requires a nurse’s expertise2. The nurse needs to assess the surgical site for signs of infection or complications, which is beyond the scope of practice for an AP. Therefore, this task should not be delegated and should be performed by the nurse herself
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