The nurse is caring for a 52-year-old male patient with a bowel obstruction. Which of these signs would be the earliest indicator to the nurse that the patient is developing symptoms of shock?
Urine output 18 mL/hr.
Blood pressure 88/50 mmHg.
Lethargy.
Pulse 110 bpm.
The Correct Answer is A
Choice A reason: A urine output of 18 mL/hr is significantly lower than the normal range (typically around 0.5-1 mL/kg/hr), indicating possible renal hypoperfusion, an early sign of shock.
Choice B reason: While blood pressure is an important indicator, it may not drop until later stages of shock.
Choice C reason: Lethargy can be a sign of shock, but it is a more subjective and later symptom compared to the objective measure of urine output.
Choice D reason: An elevated pulse is a compensatory mechanism in shock, but it is not as specific an early indicator as a decrease in urine output.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
Explanation
Choice A reason: Observing nonverbal communication is a valid nursing intervention for assessing a patient's anxiety level.
Choice B reason: Maximizing stimuli can overwhelm a patient with anxiety and is not a recommended intervention.
Choice C reason: Discouraging activities is not recommended as activities can be a form of therapy for anxiety disorders.
Choice D reason: Documenting only positive changes is not appropriate as all changes, positive or negative, should be documented for a comprehensive understanding of the patient's condition.
Choice E reason: Encouraging patients to verbalize thoughts and feelings is a therapeutic intervention that can help manage anxiety.
Choice F reason: Observing for signs of suicidal thoughts is crucial as anxiety disorders can increase the risk of suicide.
Correct Answer is D
Explanation
Choice A reason: While bulimia can contribute to gastrointestinal issues, it is not as directly linked to peptic ulcers as the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Choice B reason: Drinking green tea is not typically associated with an increased risk of peptic ulcers.
Choice C reason: Consuming spicy foods is a commonly believed risk factor, but it is not supported by strong evidence as a direct cause of peptic ulcers.
Choice D reason: The use of NSAIDs, such as ibuprofen, is a well-established risk factor for the development of peptic ulcers due to their effect on the stomach lining.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today