Taylor Chapter 24 Vital Signs Prep U
Questions And Answers 2022
Nurse T. has auscultated Mr. Weinstein's apical pulse while a colleague
simultaneously palpated his radial pulse. This assessment of Mr. Weinstein's
apical/radial pulse indicates that the two values differ significantly, a finding that
suggests which of the following health problems? - Answer- Peripheral vascular
disease
Explanation:
A pulse deficit indicates that all of the heartbeats are not reaching the peripheral
arteries or are too weak to be palpated, a finding that is congruent with peripheral
vascular disease. It does not signal a lack of circulation to the heart muscle
(coronary artery disease), a pulmonary embolism, or COPD.
Which peripheral pulse site is generally used in emergency situations? - Answer-
Carotid
Explanation:
The carotid artery is lightly palpated to obtain a pulse in emergency assessments,
such as in a patient in shock or cardiac arrest. The brachial pulse site is used for
infants who have had a cardiac arrest
A nurse plans to measure the temperature of a client with mild diarrhea, but the
client has just had hot soup. Which of the following actions should the nurse perform
in order to obtain the accurate temperature of the client? - Answer- Wait for 15 to 20
minutes before measuring the oral temperature
Explanation:
The nurse should wait for 15 to 20 minutes and then measure the oral temperature
of the client because hot and cold liquids cause slight variations in temperature.
Giving the client a glassful of cold water to drink will not help because the
thermometer will still show temperature variation and not the accurate body
temperature. The rectal route is contraindicated in clients with diarrhea because it
can cause mucosal tearing or perforation. Hence, the nurse should not lubricate the
client's rectum or measure the rectal temperature. The axillary route is the least
accurate and least reliable site because temperature may reflect the temperature of
the water used during sponging. Friction used to dry the skin may also influence the
temperature.
The nursing student is selecting a blood pressure cuff prior to obtaining a patient's
blood pressure. What cuff width is appropriate to obtain an accurate blood pressure
reading? - Answer- 40% of the circumference of the limb to be used
Explanation:
The width of the cuff should be about 40% of the circumference of the limb to be
used.
Questions And Answers 2022
Nurse T. has auscultated Mr. Weinstein's apical pulse while a colleague
simultaneously palpated his radial pulse. This assessment of Mr. Weinstein's
apical/radial pulse indicates that the two values differ significantly, a finding that
suggests which of the following health problems? - Answer- Peripheral vascular
disease
Explanation:
A pulse deficit indicates that all of the heartbeats are not reaching the peripheral
arteries or are too weak to be palpated, a finding that is congruent with peripheral
vascular disease. It does not signal a lack of circulation to the heart muscle
(coronary artery disease), a pulmonary embolism, or COPD.
Which peripheral pulse site is generally used in emergency situations? - Answer-
Carotid
Explanation:
The carotid artery is lightly palpated to obtain a pulse in emergency assessments,
such as in a patient in shock or cardiac arrest. The brachial pulse site is used for
infants who have had a cardiac arrest
A nurse plans to measure the temperature of a client with mild diarrhea, but the
client has just had hot soup. Which of the following actions should the nurse perform
in order to obtain the accurate temperature of the client? - Answer- Wait for 15 to 20
minutes before measuring the oral temperature
Explanation:
The nurse should wait for 15 to 20 minutes and then measure the oral temperature
of the client because hot and cold liquids cause slight variations in temperature.
Giving the client a glassful of cold water to drink will not help because the
thermometer will still show temperature variation and not the accurate body
temperature. The rectal route is contraindicated in clients with diarrhea because it
can cause mucosal tearing or perforation. Hence, the nurse should not lubricate the
client's rectum or measure the rectal temperature. The axillary route is the least
accurate and least reliable site because temperature may reflect the temperature of
the water used during sponging. Friction used to dry the skin may also influence the
temperature.
The nursing student is selecting a blood pressure cuff prior to obtaining a patient's
blood pressure. What cuff width is appropriate to obtain an accurate blood pressure
reading? - Answer- 40% of the circumference of the limb to be used
Explanation:
The width of the cuff should be about 40% of the circumference of the limb to be
used.
