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The nurse is caring for a patient with respiratory problems. Which assessment finding indicates a late sign of hypoxia?

A.

Elevated blood pressure

B.

Increased pulse rate

C.

Cyanosis

D.

Restlessness

Answer and Explanation

The Correct Answer is C

A. Elevated blood pressure may occur with various conditions but is not a specific late sign of hypoxia.  

 

B. An increased pulse rate can be an early compensatory response to hypoxia rather than a late sign.  

 

C. Cyanosis, which is a bluish discoloration of the skin and mucous membranes, is a classic late sign of hypoxia, indicating severe oxygen deprivation.  

 

D. Restlessness may indicate early signs of hypoxia or anxiety rather than a late sign and can occur before cyanosis develops.


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View Related questions

Correct Answer is D

Explanation

A. Chest physiotherapy is used to mobilize secretions and improve lung function, not specifically for increasing stroke volume or preload.

B. Diuretics would decrease preload by removing excess fluid, which is counterproductive in a patient with inadequate stroke volume related to decreased preload.

C. Vasodilators can further decrease preload and are not appropriate in this scenario where preload needs to be increased.

D. Intravenous (IV) fluids are administered to increase preload and improve stroke volume by enhancing the circulating blood volume.

Correct Answer is ["A","B","C","D","F"]

Explanation

A. Applying knowledge of disease processes is essential in preventing the spread of infections and understanding transmission routes.

B. Proper disposal of supplies is crucial in minimizing the risk of cross-contamination and infection spread.

C. Checking the negative-pressure system is critical to ensure it functions properly to contain airborne pathogens.

D. Hand hygiene is a key practice in preventing infection and should be performed before and after patient contact in both scenarios.

E. This statement is misleading; while some precautions may overlap, there are specific differences that must be addressed in interventions for airborne versus contact precautions.

F. It is important for patients in airborne precautions to wear a mask during transportation to prevent the spread of infectious particles.

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