A nurse is required to document an adult client's blood pressure. Which nursing
interventions will help ensure that the systolic reading is not underestimated?
A) Assist the client to a comfortable position before assessing the pressure
B) Center the cuff's bladder above the site where the brachial pulse is palpated
C) Check that the aneroid manometer is vertical and at eye level
D) Inflate the cuff to a pressure 30 mm Hg above the point where the pulse disappears
D
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The client had a classical uterine incision for her cesarean birth. The nurse knows that the client understands implications for future pregnancies that are secondary to her classical uterine incision when the client states:
1. "The next time I have a baby, I can try to deliver vaginally." 2. "The risk of rupturing my uterus is too high for me to have any more babies." 3. "Every time I have a baby, I will have to have a cesarean delivery." 4. "I can only have one more baby."
Which of the following is produced when intravascular hydrostatic pressure increases above the hydrostatic pressure within the dermal layer?
A) Keratin B) Water C) Edema D) Insult
Pain control is a nursing priority in patients with acute pancreatitis because pain:
a. increases pancreatic secretions. b. is caused by decreased distention of the pancreatic capsule. c. decreases the patient's metabolism. d. is caused by dilation of the biliary system.
The client is one hour post aortic aneurysm repair. Over the previous one hour, the client's pulse rate has steadily increased from 80 to 110, with a gradual drop in blood pressure from 120/80 to 100/70. The nurse's best action is to:
a. notify the anesthesiologist, because the client may be reacting to the anesthesia. b. continue to monitor the vital signs; it is normal to experience this after surgery. c. ask the client if the pain level can be rated on a scale of 1-10. d. continue to monitor the vital signs, because the change is probably related to the client experiencing pain.