Difficulty: Medium
Average Score: 85%
Simulated
The nurse recognizes that the client is manifesting early signs of hypoxia when the assessment data includes:
Correct answer
B
Rationale
The correct answer is B - restlessness, confusion, tachycardia. Early signs of hypoxia include restlessness and confusion due to the brain not receiving enough oxygen. Tachycardia is the body's compensatory mechanism to increase oxygen delivery. Bradycardia and lethargy (A) are not usually seen in early hypoxia. Bradycardia, dyspnea, and cyanosis (C) are more indicative of late-stage hypoxia. Hypotension and vomiting (D) are not typical signs of hypoxia.