A nurse is providing teaching about blood pressure measurement to a client who has hypertension. Which of the following instructions should the nurse include?
Use an electronic device.
Inflate the cuff to 140/90 mmHg.
Place the cuff on the upper arm.
Measure blood pressure after exercise.
The Correct Answer is C
Choice A reason: Using an electronic device is not a reliable method for measuring blood pressure because it may give inaccurate readings due to movement, noise, or battery issues. An electronic device should be calibrated regularly and compared with a manual device.
Choice B reason: Inflating the cuff to 140/90 mmHg is not a correct procedure for measuring blood pressure because it may cause discomfort and false readings. The cuff should be inflated to about 20 to 30 mmHg above the expected systolic pressure or until the pulse disappears.
Choice C reason: Placing the cuff on the upper arm is a correct procedure for measuring blood pressure because it ensures that the cuff is at the same level as the heart and that the brachial artery is compressed. The cuff should be snug and fit around 80% of the arm circumference.
Choice D reason: Measuring blood pressure after exercise is not a good time for measuring blood pressure because it may reflect a temporary increase due to physical activity. Blood pressure should be measured after resting for at least 5 minutes in a quiet and comfortable environment.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Soaking fruits in water before peeling them is not a good practice for retaining nutrients because it can cause water-soluble vitamins, such as vitamin C and B-complex vitamins, to leach out into the water. It is better to wash fruits briefly under running water and peel them as thinly as possible.
Choice B reason: Cooking vegetables for the week and reheating them at each meal is not a good practice for retaining nutrients because it can cause nutrient losses due to exposure to heat, light, air, and water. It is better to cook vegetables as close to the time of consumption as possible and use minimal water and cooking time.
Choice C reason: Boiling vegetables on the stove until they are soft is not a good practice for retaining nutrients because it can cause significant nutrient losses due to high temperature and long cooking time. It is better to steam, microwave, or stir-fry vegetables until they are crisp-tender and retain their color and texture.
Choice D reason: Keeping ripe fruits refrigerated until eating them is a good practice for retaining nutrients because it can slow down the ripening process and prevent spoilage. Refrigeration can preserve the freshness, flavor, and nutritional value of fruits. However, some fruits, such as bananas, tomatoes, and avocados, should not be refrigerated because they can lose their quality and taste.
Correct Answer is C
Explanation
Choice A reason: Using liquids to clear food from the client's mouth is not a safe intervention for dysphagia. Liquids can easily enter the airway and cause aspiration, which is the inhalation of food or fluids into the lungs. Aspiration can lead to pneumonia, respiratory distress, and death.
Choice B reason: Tilting the client's head backwards to facilitate swallowing is not a safe intervention for dysphagia. This position can also increase the risk of aspiration, as it opens the airway and allows food or fluids to flow into it.
Choice C reason: Adding a thickening agent to liquids is a safe and effective intervention for dysphagia. Thickened liquids are easier to swallow and control, as they move more slowly through the mouth and throat. They also reduce the risk of aspiration, as they are less likely to enter the airway.
Choice D reason: Placing the client in a semi-Fowler's position is not a safe intervention for dysphagia. This position can also increase the risk of aspiration, as it lowers the head and neck and reduces the closure of the airway. A better position for dysphagia is upright or high-Fowler's, which elevates the head and neck and enhances the closure of the airway.
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