A patient with gastrointestinal bleeding has hemoglobin of 8.5 g/dL. While receiving care the patient becomes anxious and irritable and bright red drainage appears through the nasogastric tube
The patient's vital sign measurements are pulse 130 beats/minute, blood pressure 105/55 mm Hg, and respirations 28/minute. What should the nurse recognize as causing the changes in the patient's vital signs?
a. Early shock
b. Patient anxiety
c. Progressive shock
d. Parasympathetic response
ANS: A
When blood pressure falls, the body activates the sympathetic nervous system to increase cardiac output by causing the heart to beat faster and stronger. Compensatory responses produce the classic signs and symptoms of early shock: tachycardia; tachypnea; restlessness; anxiety; and cool, clammy skin with pallor. B. C. D. The patient's change in vital signs is not caused by anxiety, progressive shock, or a parasympathetic response.
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When auscultating the chest of a 75-year-old patient who recently experienced a myocardial infarction (MI), the nurse hears an S3 heart sound immediately following S2. Because of this finding, the nurse should assess for which other condition?
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