A nurse is collecting data on client who has a heart rate of 56/min. Which of the following findings should the nurse expect?

Hypoglycemia

Report of dizziness

Temperature of 39° C (102.2° F).

History of cigarette smoking

Answer and Explanation

The Correct Answer is B

A: Hypoglycemia does not directly correlate with a lower heart rate.

B: A heart rate of 56/min may indicate bradycardia, which can lead to symptoms like dizziness due to decreased cardiac output and subsequently reduced cerebral perfusion.
C: A fever would typically increase the heart rate, not decrease it.

D: Cigarette smoking is more commonly associated with an increased heart rate due to stimulants like nicotine.

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Correct Answer is B

Explanation

A: The daughter's anxiety is secondary information and not directly related to the patient's health status.
B: The patient's self-reported medical history is primary data as it comes directly from the patient and provides essential information for the assessment.
C: The spouse's report of the patient's difficulty sleeping is secondary information and not directly observed or reported by the patient.
D: The caregiver's complaint is secondary information and does not provide direct insight into the patient's health status.

A. Request assistance from a second nurse. B. Count the client's apical pulse. C. Check the client's pulse rate for 1 min. D. Calculate the difference between the client's peripheral pulse and the client's apical pulse.

Correct Answer is A

Explanation

A: To accurately determine a pulse deficit, one nurse must listen to the apical pulse while another nurse palpates the radial pulse simultaneously to compare both pulse rates, necessitating a second person.
B: Counting the apical pulse is a part of the process but would follow after ensuring another nurse is available to check the radial pulse at the same time.

C: This action relates to checking a pulse rate generally but does not specify the need for simultaneous comparison with the apical pulse.
D: Calculation of the difference is the final step after both pulses have been counted simultaneously.

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A nurse is collecting data on client who has a heart rate of 56/min. Which of the following findings should the nurse expect?

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