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 D
Explanation
Choice A reason: Simultaneously palpating both carotid arteries is dangerous, risking reduced cerebral blood flow, especially in cardiovascular patients. Using the bell to listen for bruits is safer, so this is incorrect.
Choice B reason: Deep breaths are for lung auscultation, not carotid, where patients hold breath to reduce noise. The bell detects low-pitched bruits, so instructing deep breaths is incorrect for carotid assessment.
Choice C reason: Compressing the carotid artery risks reducing blood flow or dislodging plaques, which is unsafe. Listening with the bell for bruits is the standard method, so this is incorrect.
Choice D reason: Listening with the bell of the stethoscope detects low-frequency bruits, indicating carotid artery narrowing, which is critical in cardiovascular disease. This is the correct technique for safe assessment.
Correct Answer is D
Explanation
Choice A reason: Referred pain originates in one area but is felt elsewhere, not due to abnormal impulse processing. Neuropathic pain involves nerve dysfunction, so this is incorrect for the pain type described.
Choice B reason: Visceral pain arises from internal organs, not nerve processing issues. Neuropathic pain results from abnormal peripheral or central nerve activity, so this is incorrect for the pain mechanism.
Choice C reason: Cutaneous pain is skin-related, caused by direct stimuli, not abnormal nerve processing. Neuropathic pain involves nerve dysfunction, making this incorrect for the described pain type.
Choice D reason: Neuropathic pain results from abnormal pain impulse processing in the peripheral or central nervous system, such as in neuropathy or nerve injury. This matches the description, making it the correct choice.
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