A patient’s blood pressure is 118/82 mm Hg. He asks the nurse, “What do the numbers mean?” What is the nurse’s best reply?
“The top number is the systolic blood pressure and reflects the pressure of the blood against the arteries when the heart contracts.”
“The bottom number is the diastolic pressure and reflects the stroke volume of the heart.”
“The concept of blood pressure is difficult to understand. The primary thing to be concerned about is the top number, or the systolic blood pressure.”
“The numbers are within normal range and are nothing to worry about.”
The Correct Answer is A
Choice A reason: The systolic pressure (top number) measures arterial pressure during heart contraction, accurately explaining 118/82 mm Hg. This clear, correct definition educates the patient, making it the best reply.
Choice B reason: Diastolic pressure (bottom number) reflects arterial pressure at rest, not stroke volume. Systolic pressure is correctly defined as contraction pressure, so this is incorrect for explaining the numbers.
Choice C reason: Dismissing blood pressure as complex is unhelpful; both numbers matter. Systolic pressure is accurately defined as heart contraction pressure, so this is incorrect for patient education.
Choice D reason: Stating the numbers are normal (118/82 is prehypertension) avoids explaining their meaning. Defining systolic pressure clarifies the reading, so this is incorrect for answering the question.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
hoice A reason: Symmetry is a benign mole feature; asymmetry is concerning for melanoma. Burning and bleeding with irregular edges raise cancer risk, so symmetry is not the concerning finding here.
Choice B reason: Irregular edges, combined with burning and bleeding, are concerning for melanoma, per the ABCDE criteria (Asymmetry, Border irregularity). This suggests malignancy, making it the correct additional finding to worry about.
Choice C reason: Diameter less than 6 mm is less concerning; melanomas are often >6 mm. Irregular edges with symptoms are more indicative of cancer, so this is not the priority finding.
Choice D reason: Consistent color is benign; variegated colors suggest malignancy. Irregular edges with burning/bleeding are more alarming, so consistent color is incorrect for the concerning finding.
Correct Answer is C
Explanation
Choice A reason: A nodule is a solid, elevated lesion, typically greater than 1 cm in diameter, often extending deeper into the dermis or subcutaneous tissue. The lesion described is less than 1 cm, making nodule an incorrect term for this superficial, smaller skin finding.
Choice B reason: A wheal is a transient, elevated lesion caused by dermal edema, often associated with allergic reactions or urticaria. It is not solid and typically lacks the circumscribed nature of the described lesion, making wheal an inappropriate documentation term.
Choice C reason: A papule is a solid, elevated, circumscribed lesion less than 1 cm in diameter, often due to localized skin changes like inflammation or benign growths. This matches the described lesion’s characteristics, making papule the correct term for documentation.
Choice D reason: A pustule is an elevated lesion containing pus, often associated with infections like acne. The described lesion is solid, not fluid-filled, so pustule does not fit the clinical presentation, making it an incorrect choice.
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