A nurse is administering nicardipine to a client who has a BP of 180/120 mm Hg. Which of the following actions should the nurse take first?

Check for orthostatic hypertension.

Assist the client to make lifestyle changes.

Instruct the client to restrict sodium intake.

Monitor the client's BP every 5 minutes.

Answer and Explanation

The Correct Answer is D

A. Check for orthostatic hypotension. While important, checking for orthostatic hypotension is not the priority action in a hypertensive emergency, where rapid blood pressure reduction is necessary.

B. Assist the client to make lifestyle changes. Assisting the client with lifestyle changes is part of long-term blood pressure management but is not a priority action when administering nicardipine for acute hypertension.

C. Instruct the client to restrict sodium intake. Sodium restriction is a key component of managing hypertension but is not the priority action during an acute hypertensive crisis.

D. Monitor the client's BP every 5 minutes. In a hypertensive crisis, frequent monitoring of the client’s blood pressure is essential to ensure the medication is lowering blood pressure safely and effectively.

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Correct Answer is "{\"xRanges\":[80.828125,100.828125],\"yRanges\":[129,149]}"

Explanation

To auscultate the apical pulse, the nurse should place the stethoscope at the fifth intercostal space at the midclavicular line on the left side of the chest. This is the location of the apex of the heart, also referred to as the point of maximal impulse (PMI).

A. Popliteal B. Brachial C. Femoral D. Carotid

Correct Answer is D

Explanation

A. Popliteal: Checking the popliteal pulse bilaterally is generally safe, as it does not carry the risk of compromising blood flow to the brain.

B. Brachial: Checking the brachial pulse bilaterally is safe and does not compromise circulation to vital organs.

C. Femoral: The femoral pulse can be checked bilaterally without causing significant issues.

D. Carotid: Checking the carotid pulse bilaterally can reduce blood flow to the brain and lead to syncope (fainting), so it should be avoided. Palpating one carotid artery at a time is the correct approach.

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A nurse is administering nicardipine to a client who has a BP of 180/120 mm Hg. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is counting a client's apical pulse rate. Identify where the nurse should place the stethoscope to auscultate the apical pulse. (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)

Correct Answer is "{\"xRanges\":[80.828125,100.828125],\"yRanges\":[129,149]}"

Explanation

A nurse is collecting data about a client's circulatory system. Which of the following pulse sites should the nurse avoid checking bilaterally at the same time?

Correct Answer is D

Explanation

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