What is the earliest sign of shock that the nurse would monitor for during a routine assessment?

Restlessness

Pale skin

Complaints of thirst

Complaints of nausea

Answer and Explanation

The Correct Answer is A

A) Restlessness.
Restlessness is often one of the earliest signs of shock. It reflects the body's attempt to compensate for decreased tissue perfusion and oxygen delivery by increasing sympathetic nervous system activity. Restlessness may manifest as agitation, fidgeting, or an inability to sit still. It is an important clinical indicator that suggests impending hemodynamic instability and warrants prompt assessment and intervention.

B) Pale skin:
Pale skin is a common sign of shock, but it may not always be the earliest manifestation. Pale skin typically occurs later in the progression of shock as vasoconstriction occurs, redirecting blood flow away from the skin to vital organs in an attempt to maintain perfusion.

C) Complaints of thirst:
While complaints of thirst may indicate dehydration or fluid loss, they are not typically considered the earliest sign of shock. Thirst usually occurs after the body has already begun to experience fluid deficit and may not be apparent until shock is more advanced.

D) Complaints of nausea:
Nausea may occur in shock due to decreased perfusion to the gastrointestinal tract, but it is not usually the earliest sign. Nausea may develop as shock progresses and metabolic disturbances worsen, but it is often preceded by other symptoms such as restlessness or altered mental status.

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Correct Answer is B

Explanation

A) Antihistamines:
Antihistamines are commonly used in the treatment of allergic reactions, including anaphylaxis. They work by blocking the effects of histamine, which is released during an allergic reaction, and can help alleviate symptoms such as itching, hives, and nasal congestion. Antihistamines are typically included in the treatment regimen for anaphylaxis but should not be relied upon as the sole treatment.

B) Vasodilators.
Vasodilators are medications that widen blood vessels, leading to a decrease in blood pressure. In the context of anaphylaxis, where blood pressure can drop precipitously due to systemic vasodilation, the use of vasodilators can exacerbate hypotension, potentially worsening the patient's condition. Therefore, vasodilators should be avoided in the management of anaphylaxis.

C) Corticosteroids:
Corticosteroids, such as prednisone or methylprednisolone, are used in the management of anaphylaxis to reduce inflammation and prevent late-phase allergic reactions. They are not typically used as first-line treatment during the acute phase of anaphylaxis but may be administered after initial stabilization to prevent recurrence of symptoms.

D) Bronchodilators:
Bronchodilators, such as albuterol, are used to relieve bronchospasm and improve airflow in conditions such as asthma and chronic obstructive pulmonary disease (COPD). While bronchospasm can occur during anaphylaxis, bronchodilators may still be used to address this symptom. However, they should be used cautiously, and their administration should not delay the administration of epinephrine, which is the primary treatment for anaphylaxis.

A. H2-receptor blockers B. Antacids C. Proton-pump inhibitors D. Antibiotics

Correct Answer is D

Explanation

A) H2-receptor blockers:
H2-receptor blockers, such as ranitidine and famotidine, are used to reduce the production of stomach acid. While they can provide symptomatic relief for ulcers by reducing acid secretion, they do not directly treat the underlying cause of the ulcer, which is the H. pylori infection.

B) Antacids:
Antacids are medications that neutralize stomach acid and can provide temporary relief from ulcer symptoms such as pain and discomfort. However, they do not eradicate the H. pylori bacteria or address the root cause of the ulcer. Antacids only provide symptomatic relief rather than treating the infection.

C) Proton-pump inhibitors:
Proton-pump inhibitors (PPIs), such as omeprazole and pantoprazole, are potent acid-suppressing medications that are commonly used to treat ulcers and gastroesophageal reflux disease (GERD). While they can help in ulcer healing by reducing acid secretion and providing symptomatic relief, they are not effective in eradicating H. pylori infection. PPIs are often used in combination with antibiotics for H. pylori eradication therapy, but they are not the primary treatment on their own.

D) Antibiotics.
H. pylori (Helicobacter pylori) is a bacteria that commonly infects the stomach lining and is a major cause of gastric and duodenal ulcers. Antibiotics are the primary treatment for H. pylori infection. The antibiotics kill the bacteria, allowing the ulcer to heal. Common antibiotics used to treat H. pylori include amoxicillin, clarithromycin, metronidazole, and tetracycline.

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What is the earliest sign of shock that the nurse would monitor for during a routine assessment?

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Naxlex Comprehensive Predictor Exams

In reviewing a plan of care for a patient exhibiting the symptoms of anaphylaxis, which of the following medications would be avoided?

Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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