PN study Set 1 (ATI) Exam Questions with Complete Solutions

Hypoxia s/s (4) - ANSWER-1. Fatigue (decreased energy production) 2. Tachypnea (increased respiratory rate) 3. Tachycardia (increased heart rate to circulate red blood cells more freely) 4. Pallor (pale skin and mucous membranes caused by decreased red blood cells in blood vessels) Note: Assess for anemia by checking inside of person's mouth for pale colored mucosa and gums. Indicators of severe Hypoxia (3) - ANSWER-d position of accessory muscles 3. cyanosis Symptoms of Hypoxia Early vs Late s/s: - ANSWER-Early RAT is Late to BED R- restlessness A- anxiety T- tachycardia/ tachypnea B-bradycardia - E- extreme restlessness- D- dyspnea (severe) s/s of neurogenic shock - ANSWER-hypotension, bradycardia, hypothermia Hypervolemia - ANSWER-Swelling in extremities, weight gain, fatigue, or shortness of breath Dehydration s/s, mild, moderate and severe. - ANSWER-*S/S*: fever, tachycardia, decreased BP, tachypnea, weak and thready pulse low serum potassium levels. increase in rr. slow capillary refill time. Mild: 3-5% reduction in urine output *Moderate dehydration*: (6-9%) Dry mucous membranes, decreased skin tugor. tachycardia, deep respirations irritability sunken fontanelles in infants *Severe dehydration*: (more than 10%) weight loss more than 10% in infant. Eyes very sunken. lethargic or unconscious (floppy. Hypotension, lethargy, capillary refit greater than 3 seconds Lab findings of dehydration - ANSWER-HGB: Urine Specific Gravity: Elevated Urine osmolality: Hematocrit: Elevated Temperature Adult and child - ANSWER-Adult: Normal range: *97.0 F to 99.5* F - or - 2 degrees above the known baseline. Newborn: *97.5-100.4* o Technically, a person is considered to have a "fever" if the temperature is 100.4 F., however, this is not usually clinically significant until the