A nurse is preparing to palpate a client's systolic blood pressure using the brachial artery. After applying the blood pressure cuff to the client's arm, identify the sequence of steps the nurse should follow. (Arrange the steps, placing them in the order of performance. Use all the steps.)
Palpate the brachial pulse site.
Discontinue palpation of the brachial pulse.
Inflate the blood pressure cuff to 30 mm Hg beyond where the brachial pulse was last felt.
Deflate the blood pressure cuff slowly until the brachial pulse is detected.
The Correct Answer is A, C, B, D
First, the nurse should palpate the brachial pulse site to locate the artery. Next, the nurse should inflate the blood pressure cuff to 30 mm Hg beyond where the brachial pulse was last felt. The nurse should then discontinue palpation of the brachial pulse and deflate the blood pressure cuff slowly until the brachial pulse is detected. This is the point at which the systolic blood pressure can be read.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
If a nurse is caring for an older adult client who tells the nurse that they have smoked one pack of cigarettes every day for the last 60 years, the next action the nurse should take is to ask what the client knows about the effects of smoking. This will help the nurse assess the client's knowledge and understanding of the risks associated with smoking and provide an opportunity for education.
Option b is incorrect because working with the client to establish a quit date is important but not the next intervention.
Option c is incorrect because suggesting that the client use nicotine gum to facilitate quitting is important but not the next intervention.
Option d is incorrect because referring the client to a local smoking cessation program is important but not the next intervention.
Correct Answer is B
Explanation
When providing preoperative teaching to a client over the phone in preparation for outpatient surgery, the nurse should explain the need for the client to have another adult drive them home following surgery. This is because the client may still be affected by anesthesia and may not be able to safely operate a vehicle.
a. Asking the client to shower 3 times the day before surgery is not necessary and may dry out the skin.
c. The client should typically stop drinking clear liquids 2 hours before surgery, not 1 hour.
d. The client should not wear makeup during surgery as it can interfere with the monitoring of their skin color and oxygen saturation.
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