If a patient's blood pressure measures 146/92 on the left arm and 138/84 on the right arm, what would you do?

Wait 30 minutes and take the pressures again.

Record both pressures in the medical record.

Retake the pressure on both arms.

Retake the pressure on the left arm.

Answer and Explanation

The Correct Answer is C

A.   Waiting 30 minutes is unnecessary unless there is concern about an acute change in the patient's condition.
B.   While both readings can be recorded, the difference between arms should be noted, as it can indicate underlying issues such as vascular problems.

C.   It is important to retake the blood pressure on both arms to verify accuracy and check for any significant discrepancy.
D.   Retaking the pressure on just one arm may miss important information about the other arm's readings.

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Correct Answer is A

Explanation

A. This is because the patient's blood pressure of 98/66 mm Hg, while on the lower side, may be normal for them. It's important to compare it to their baseline to determine if there has been a significant change.
B. The blood pressure is within a normal range for an adult, so immediate notification of hypotension is not required.
C. This can be done after determining if there is a significant change from the baseline.
D. The pulse is not bradycardic (it is within a normal range), so there is no immediate need to notify the doctor regarding bradycardia.

A. auscultate lung and abdominal sounds. B. check for verbal and motor response. C. monitor daily weight. D. monitor intake and output.

Correct Answer is B

Explanation

A. While auscultating lung and abdominal sounds is important, it is not as urgent as checking neurological function in a head trauma patient.
B. Assessing verbal and motor responses is critical to evaluate the level of consciousness and neurological function in a patient with head trauma.
C. Monitoring daily weight is not an immediate concern for a patient with possible head trauma.
D. Monitoring intake and output is important but not the priority compared to assessing the neurological status in head trauma patients.

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If a patient's blood pressure measures 146/92 on the left arm and 138/84 on the right arm, what would you do?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A 45-year-old patient who is alert and oriented has a blood pressure of 98/66 mm Hg, radial pulse of 76 beats/min (irregular), and respirations of 18 breaths/min (regular). The best nursing intervention is to:

Correct Answer is A

Explanation

A patient was admitted with possible head trauma after a motor vehicle accident. The nursing implementation with the highest priority is to:

Correct Answer is B

Explanation

The nurse explains to a patient that the pulse oximeter can measure the arterial oxygen by:

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A type of Korotkoff sound that indicates the diastolic pressure in children and in some adults is

If a silence is heard between sounds when auscultating blood pressure, it is termed a(n)

The nurse covers a newborn baby's head with a cap. because the head:

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The nurse tells a patient that he will be performing a visual acuity test using the Snellen eye chart. The patient asks how the test is done. The nurse's best reply is: