Which method will provide the most accurate measurement of the patient's heart rate?
apical
radial
brachial
popliteal
The Correct Answer is A
A. Apical. The apical pulse, located at the apex of the heart, provides the most accurate measurement of heart rate, especially in patients with irregular rhythms. It is assessed by auscultation with a stethoscope over the fifth intercostal space at the midclavicular line.
B. Radial. The radial pulse is commonly used for routine pulse checks, but it may be less accurate in cases of irregular heart rhythms or weak peripheral circulation.
C. Brachial. The brachial pulse is typically used in infants and for blood pressure measurements, but it is not the most accurate method for assessing heart rate.
D. Popliteal. The popliteal pulse is located behind the knee and is used to assess circulation to the lower extremities, not for measuring heart rate accurately.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["10"]
Explanation
Calculation:
Volume to administer = Dose ordered/ Dose available
Given:
- Ordered dose = 10 mg
- Available concentration = 10 mg/10 mL
Volume =10mg/(10mg/10mL)
= 10mL
Thus, the nurse will administer 10 mL per dose.
Correct Answer is C
Explanation
A. Inform the patient's health care provider immediately to obtain an order for antihypertensive medications. While notifying the provider may be necessary, the nurse must first confirm the accuracy of the blood pressure reading before taking further action.
B. Instruct the nursing assistant to take the patient's blood pressure again and inform the nurse of the results immediately. Nursing assistants can take blood pressure readings, but the nurse should personally verify a critically high reading using a manual method.
C. Take the patient's blood pressure manually with a sphygmomanometer and stethoscope. Electronic monitors can sometimes give false readings, especially in patients with irregular heartbeats or movement. Manually verifying ensures an accurate assessment before determining further action.
D. Perform a neurological assessment to determine if the patient is stressed, in pain, or having a stroke. A neurological assessment is important if the elevated BP is confirmed, but the first priority is verifying the reading manually.
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