To accurately access blood pressure on a child, the nurse would select a cuff:
1. By the cuff label—infant, child, adult.
2. That covers 2/3 of the upper arm with a bladder that wraps around at least 80% of the circumference of the arm.
3. Based on availability as the size of the cuff will not influence the blood pressure.
4. That extends up to 50 % of the upper arm and the bladder covers 1/4 of the circumference of the arm.
2
Rationale 1: This does not determine the size of the cuff by the size of the child. In addition, the arm may not be used for the blood pressure assessment.
Rationale 2: This is an accurate measurement to determine cuff size.
Rationale 3: Blood pressure readings will be inaccurately high or low based on whether the cuff is too large or too small.
Rationale 4: This is incorrect and will result in a cuff that is too small.
Global Rationale:
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