A nurse is preparing to check a client's blood pressure. Which of the following actions should the nurse take?
Use a cuff with a width that is about 60% of the client's arm circumference.
Apply the cuff above the client's antecubital fossa.
Have the client sit with his arm resting above the level of his heart.
Release the pressure on the client's arm 5 to 6 mm per second.
The Correct Answer is A
When checking a client's blood pressure, the nurse should use a cuff with a width that is about 60% of the client's arm circumference. This will help to ensure that the cuff fits properly and provides an accurate reading.
Options b, c, and d are not correct. The cuff should be applied over the client's brachial artery, which is located in the antecubital fossa. The client should sit with their arm resting at the level of their heart, not above it. The pressure on the client's arm should be released at a rate of 2 to 3 mm per second, not 5 to 6 mm per second.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
When checking a client's blood pressure, the nurse should use a cuff with a width that is about 60% of the client's arm circumference. This will help to ensure that the cuff fits properly and provides an accurate reading.
Options b, c, and d are not correct. The cuff should be applied over the client's brachial artery, which is located in the antecubital fossa. The client should sit with their arm resting at the level of their heart, not above it. The pressure on the client's arm should be released at a rate of 2 to 3 mm per second, not 5 to 6 mm per second.
Correct Answer is A
Explanation
The nurse should respect the client's autonomy and right to make decisions about their own care. Referring the client to hospice care is an appropriate response because it provides the client with support and care in their own home.
Options b, c, and d are not appropriate responses because they do not respect the client's autonomy.
Option b suggests that the client needs to discuss their decision with their family before making a decision, which may not be necessary or desired by the client.
Option c confronts the client with the reality of their illness in a potentially insensitive manner.
Option d suggests that the client is giving up too soon, which may not be an accurate or helpful assessment of the situation.
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