A nurse is collecting data from a client who has diabetic ketoacidosis.
Which of the following findings should the nurse expect?
Elevated blood pressure.
Clammy skin.
Fruity breath odor.
Bounding pulse.
The Correct Answer is C
Choice A rationale:
Elevated blood pressure is not typically associated with diabetic ketoacidosis (DKA) In fact, individuals with DKA often experience low blood pressure due to dehydration.
Choice B rationale:
Clammy skin can occur in DKA due to dehydration and metabolic disturbances, but it is not a specific finding that differentiates DKA from other conditions.
Choice D rationale:
A bounding pulse is not a characteristic finding in DKA. Individuals with DKA may have a rapid pulse due to the stress on the body, but it is not typically described as bounding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
"Fidelity involves ensuring that we do no harm to the client." - This statement is not an accurate description of fidelity. Fidelity, in ethical terms, primarily refers to keeping promises and being loyal to clients, rather than preventing harm.
Choice B rationale:
"Fidelity involves making sure clients are able to make their own health care decisions." - While this statement relates to ethical principles, it is more closely associated with the principle of autonomy rather than fidelity. Fidelity is about keeping promises and being trustworthy.
Choice C rationale:
"Fidelity involves keeping promises made to clients." - This is the correct answer. Fidelity is the ethical principle that involves keeping commitments, promises, and agreements made to clients. It emphasizes the importance of honesty, trustworthiness, and integrity in the nurse-patient relationship.
Choice D rationale:
"Fidelity involves treating every client with the same level of respect." - While respecting clients is essential in nursing practice, this statement does not directly address the concept of fidelity. Fidelity is more about keeping promises and being loyal to individual clients rather than a uniform approach to all clients.
Correct Answer is D
Explanation
Choice A rationale:
Delaying the discussion about managing hair loss when the client has expressed concern is not the best approach. The nurse should provide information and support when the client seeks it.
Choice B rationale:
Discouraging the client from worrying about hair loss at this moment is not empathetic. The client's concerns should be acknowledged and addressed.
Choice C rationale:
Expressing empathy and relating to the client's emotional experience is a good practice, but it does not directly answer the client's question about managing hair loss.
Choice D rationale:
Offering to get information about head-covering options indicates an understanding of the client's concerns and provides a proactive solution. It shows empathy and willingness to support the client during chemotherapy, where hair loss can be a significant emotional issue.
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