A nurse is taking a blood pressure measurement to assess for orthostatic hypotension in a client. Which signs and symptoms will the nurse assess related to this condition? (Select all that apply.)
Client reports feeling dizzy when sitting up from a supine position.
Client reports feeling palpitations when rising from a supine to a standing position.
Erythema is present on the bilateral lower extremities
The client has a temperature of 100.4 F
The client states, “I feel lightheaded when sitting up.”
Correct Answer : A,D,E
A. Client reports feeling dizzy when sitting up from a supine position.
Dizziness or lightheadedness when moving from a lying down to a sitting or standing position can be indicative of orthostatic hypotension.
B. Client reports feeling palpitations when rising from a supine to a standing position.
Palpitations (feeling of rapid or irregular heartbeat) can be associated with orthostatic changes and may indicate the heart's compensatory response to low blood pressure.
C. Erythema is present on the bilateral lower extremities.
Erythema (redness of the skin) is not typically associated with orthostatic hypotension. This symptom is more likely related to skin conditions or other causes.
D. The client has a temperature of 100.4 F.
Fever (elevated body temperature) is not a direct symptom of orthostatic hypotension. Orthostatic hypotension is primarily related to changes in blood pressure upon assuming an upright position.
E. The client states, “I feel lightheaded when sitting up.”
Lightheadedness upon sitting up or standing is a common symptom of orthostatic hypotension.
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Related Questions
Correct Answer is C
Explanation
A. Edema:
Edema refers to the presence of swelling caused by an accumulation of fluid. While the nurse can observe and measure edema, the sensation of swelling itself is subjective and based on the client's perception.
B. Heart Rate:
Heart rate is an objective measure of the number of heartbeats per minute. It can be measured and observed by the healthcare provider, making it an objective data point.
C. Chills
Subjective data refers to information that is based on the client's personal experiences, perceptions, and feelings. Chills, which describe a feeling of coldness often associated with shivering, are a subjective symptom that the client experiences.
D. Pallor:
Pallor refers to an unusually pale or white skin color. While the nurse can observe and assess the color of the skin, the client's perception of pallor is subjective.
Correct Answer is ["2"]
Explanation
To administer the ordered dose of digoxin, you need to calculate how many tablets of the available strength are equivalent to 0.25 mg. You can use the formula:
Ordered dose / Available dose = Number of tablets
Plugging in the values, you get:
0.25 mg / 0.125 mg = 2 tablets
Therefore, you need to administer two tablets of digoxin 0.125 mg to give the ordered dose of 0.25 mg.
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