A nurse is caring for a client who has an irregular heart rate. Which of the following actions should the nurse take?
Check the client’s heart rate for 30 seconds.
Palpate the client’s pulse at the third intercostal space.
Ask the client to perform the Valsalva maneuver.
Auscultate the client’s apical pulse.
The Correct Answer is D
When caring for a client who has an irregular heart rate, the nurse should auscultate the client’s apical pulse to accurately assess their heart rate1. An electrocardiogram (ECG or EKG) may also be used to measure the timing and duration of each electrical phase in the heartbeat
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
In case of a fire, it is important to contain the smoke and flames by closing all doors . This can help prevent the spread of fire and smoke to other areas of the hospital and provide more time for evacuation. After
closing all doors, the nurse should follow the hospital’s fire safety plan and take further actions as necessary.
Correct Answer is A
Explanation
Fall prevention involves managing a patient’s underlying fall risk factors and optimizing the hospital’s physical design and environment1. Providing under-bed lighting at night can help reduce the risk of falls.
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