A nurse is preparing to assess a client for a pulse deficit. Which of the following actions should the nurse plan to take first?
Request assistance from a second nurse.
Count the client's apical pulse.
Check the client's pulse rate for 1 min.
Calculate the difference between the client's peripheral pulse and the client's apical pulse.
The Correct Answer is A
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
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.
Correct Answer is B
Explanation
A: Tachypnea refers to rapid breathing, typically defined as a respiratory rate exceeding 20 breaths per minute.
B: Bradypnea is characterized by abnormally slow breathing, with a respiratory rate below the normal range.
C: Eupnea describes normal breathing, with a respiratory rate within the typical range for the patient's age and health status.
D: Apnea is the absence of breathing, not merely a decreased rate, and is considered a medical emergency.
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