. A patient with active gastrointestinal bleeding is being monitored for complications. Which of the following signs indicates the patient is developing hypovolemic shock?
Elevated blood pressure
warm, flushed skin
Increased urine output
Increased heart rate
The Correct Answer is D
A. Elevated blood pressure. Blood pressure typically drops in hypovolemic shock as blood volume decreases.
B. Warm, flushed skin. As hypovolemic shock progresses, skin becomes cool and clammy due to decreased blood flow and compensatory vasoconstriction.
C. Increased urine output. Hypovolemic shock leads to decreased urine output due to reduced renal perfusion.
D. Increased heart rate. An increased heart rate is an early compensatory response in hypovolemic shock as the body attempts to maintain cardiac output.
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Correct Answer is A
Explanation
A. Hypovolemia leading to decreased renal perfusion. Hypovolemia from dehydration and low blood pressure reduces blood flow to the kidneys, resulting in pre-renal AKI, characterized by elevated BUN and creatinine.
B. Acute tubular necrosis. Acute tubular necrosis may cause AKI but is often due to prolonged hypoperfusion, nephrotoxic drugs, or ischemia, not the immediate presentation seen here.
C. Urinary tract obstruction. A urinary tract obstruction leads to post-renal AKI, often with symptoms like flank pain or difficulty urinating, not dehydration and low blood pressure.
D. Chronic kidney disease. Chronic kidney disease is a long-term condition and would not cause the acute symptoms or sudden onset of AKI as seen in this patient.
Correct Answer is A
Explanation
A. Consume small frequent meals throughout the day. Small, frequent meals reduce the volume of food entering the small intestine at one time, helping to prevent symptoms of dumping syndrome.
B. Lie down immediately after eating to aid digestion. Although lying down after eating can slow gastric emptying and help prevent dumping syndrome, it does not aid in digestion.
C. Include high-carbohydrate foods in every meal. High-carbohydrate foods are likely to worsen symptoms of dumping syndrome by causing rapid glucose absorption, which leads to a spike in insulin and subsequent hypoglycemia.
D. Drink fluids with meals to aid in digestion. Fluids should be taken between meals rather than with meals to avoid rapid gastric emptying and prevent dumping syndrome.