The student nurse is obtaining a client's respirations. Which action is appropriate when the student nurse is counting the adult client's respirations?

Question

A) Keep fingertips on the client's pulse when counting respirations.
B) Count respirations when the client is sleeping or resting.
C) Apply pressure on the client's chest when counting respirations.
D) Count the client's respirations for 1 minute.

Answer 1

A
Feedback:
The nurse should prepare to count respirations by keeping the fingertips on the client's pulse. Exercise increases respiratory rate and will not help to get a true reading. The nurse should count respirations for 30 seconds and multiply the finding by 2 to get the rate per minute. The nurse should count respirations for 1 full minute only for an infant, a young child, or an adult with an irregular, more rapid rate. The nurse should not ask the client to count respirations while taking the pulse; a client who knows the nurse is counting respirations may not breathe naturally. Respirations should be counted by placing the hand lightly, without too much pressure, on the client's chest or abdomen. Blood pressure (BP) is to be measured when the client is resting and quiet.