Difficulty: Medium
Average Score: 78%
Simulated
Passage / Scenario
Vital SignsNursesÔÇÖ Notes
Diagnostic Results
ProviderÔÇÖs Prescriptions
Postoperative day 1, 0600:
Temperature: 36.4 C (97.5 F)
Heart rate: 84/min
Respiratory rate: 18/min
Blood pressure: 106/74 mm Hg
Oxygen saturation: 97% on room air
2330:
Temperature: 36.3 C(97.3 F)
Heart rate: 104/min
Respiratory rate: 24/min
Blood pressure: 88/54 mm Hg
Oxygen saturation: 96% on room air
The nurse is continuing to assist in the care of the client.
For each data collection finding, specify if the finding on postoperative day 1 is consistent with hypovolemic shock or pulmonary embolism. Each finding may support more than one disease process or none at all.
Correct answer
B,D
Rationale
Tachycardia (heart rate 104/min) and hypotension (88/54 mm Hg) on day 1 at 2330 are consistent with hypovolemic shock due to fluid loss post-surgery.