The nurse prepares to assess the client's radial pulse. Which statement made by the nurse reflects a correct understanding of the procedure? "I will:

count the radial pulse for two minutes."

put my fingers on the "pinky" finger side of the wrist."

use my thumb to count the pulse."

count the pulse for 30 seconds and multiply the number by two

Answer and Explanation

The Correct Answer is D

D. Counting the radial pulse for 30 seconds and then multiplying the count by two gives an estimate of the client's heart rate per minute (bpm). This method is efficient and commonly used in clinical practice, especially if the client's pulse is regular.

A. Counting the radial pulse for two minutes is unnecessarily long and not standard practice. Typically, the radial pulse is counted for either 30 seconds or 60 seconds (one minute) to determine the client's heart rate. Multiplying the count by two for a 30-second count or directly using the count for a 60- second count provides the client's beats per minute (bpm).

B. The radial pulse is assessed by palpating the radial artery on the thumb side (or lateral side) of the client's wrist. The nurse places the index and middle fingers gently over the radial artery and applies light pressure to feel the pulse rhythm and rate.

C. Using the thumb to count the pulse is not recommended because the thumb has its own pulse, which could interfere with accurately assessing the client's radial pulse.

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Correct Answer is A

Explanation

A. Giving a written warning is a serious disciplinary action that should only be considered after other steps to support and assist the assistant have been taken. It does not promote a supportive or constructive approach to resolving the issue.

B. This option involves the nurse providing guidance and support to the assistant. By acting as a role model, the nurse can demonstrate the correct way to approach the task and provide alternative solutions or techniques. This approach encourages learning and professional development for the assistant.

C. While this may temporarily resolve the issue, it does not address the assistant's competency or provide an opportunity for learning and growth. It may also undermine the assistant's confidence and independence in performing the task.

D. While providing another task might offer another chance for success, it does not directly address the current difficulty with the delegated task. The nurse should focus on addressing the specific challenge at hand before assigning additional tasks.

A. was negligent, resulting in harm to the client. B. was acting on the principle of nonmaleficence. C. committed a misdemeanor. D. was unethical in her practice.

Correct Answer is A

Explanation

A. Negligence in nursing refers to the failure to provide care that meets established standards, resulting in harm to the patient. In this case, if the nurse failed to monitor vital signs as per hospital policies and this failure led to complications for the post-operative client, it could constitute negligence. Negligence involves breaching the duty of care owed to the patient, causing harm that could have been reasonably prevented.

B. Nonmaleficence is the principle of doing no harm. While it is an ethical principle guiding healthcare practice, it does not justify or excuse negligence. Negligence involves a failure to uphold the duty of care owed to the patient, resulting in harm due to substandard practice.

C. A misdemeanor typically refers to a lesser criminal offense. Negligence in healthcare generally does not rise to the level of a criminal offense like a misdemeanor unless there is gross negligence or willful misconduct. In most cases, negligence leading to harm is addressed through civil litigation rather than criminal charges.

D. While negligence can certainly be considered unethical behavior in the context of healthcare, negligence itself is a legal concept related to professional malpractice rather than solely an ethical breach. Ethical violations may involve different aspects of professional conduct not directly related to negligence, such as breaches of confidentiality or conflicts of interest.

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