A nurse is caring for a client who has a dysrhythmia. Which of the following techniques is appropriate for the nurse to use to assess for a pulse deficit?

Obtain apical and radial rates simultaneously.

Palpate pulses in the lower extremities.

Check blood pressure in left and right arms.

Compare the pulse strength in upper extremities.

Answer and Explanation

The Correct Answer is A

A. Obtaining apical and radial rates simultaneously allows the nurse to assess for a pulse deficit by comparing the two rates. A pulse deficit is present when the apical rate (heard with a
stethoscope) is greater than the radial rate (palpated at the wrist).

B.   Palpating pulses in the lower extremities is not specific for assessing a pulse deficit and may not accurately reflect the cardiac output.

C.   Checking blood pressure in left and right arms assesses for blood pressure differences but does not specifically address a pulse deficit.
D.   Comparing the pulse strength in the upper extremities does not directly assess for a pulse deficit; simultaneous assessment of apical and radial rates is more appropriate.

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Correct Answer is A

Explanation

A. Palliative surgery focuses on relieving symptoms and improving comfort rather than curing the underlying disease. Therefore, informing the client that they will be more comfortable after surgery is an appropriate instruction.
B. Palliative surgery may not necessarily provide more information about the disease.

C. Palliative surgery does not aim to restore function in the same way as corrective or restorative surgery.
D. Palliative surgery is not performed with the expectation of curing the disease; its goal is to enhance the quality of life by alleviating symptoms.

A. "Raise your head off the pillow." B. "Bear down." C. "Hold your breath." D. "Perform Kegel exercises."

Correct Answer is B

Explanation

A. Raising the head off the pillow is not relevant to easing the passage of the catheter through the urinary meatus.
B. Bearing down can help relax the pelvic floor muscles, making it easier to insert the catheter through the urinary meatus.
C. Holding the breath is not typically instructed during catheter insertion and may not aid in the ease of the procedure.
D. Performing Kegel exercises involves contracting pelvic floor muscles, which is not the desired action when inserting a urinary catheter.

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A nurse is caring for a client who has a dysrhythmia. Which of the following techniques is appropriate for the nurse to use to assess for a pulse deficit?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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