According to current guidelines, which of the following reflects a normal adult blood pressure reading?
90/80
95/60
180/60
120/80
The Correct Answer is D
Choice A reason: A blood pressure of 90/80 mmHg is below normal, indicating hypotension, especially with a low systolic value. Normal adult blood pressure, per guidelines, is around 120/80 mmHg. Low readings may suggest dehydration or cardiovascular issues, requiring evaluation, making this choice incorrect.
Choice B reason: A reading of 95/60 mmHg is hypotensive, with both systolic and diastolic values below normal ranges. Normal blood pressure is approximately 120/80 mmHg, per American Heart Association guidelines. Such low readings may indicate shock or autonomic dysfunction, rendering this choice incorrect.
Choice C reason: A blood pressure of 180/60 mmHg is abnormal, with elevated systolic pressure indicating hypertension and a low diastolic value suggesting possible aortic regurgitation. Normal blood pressure is 120/80 mmHg. This reading requires urgent assessment, making it an incorrect choice for normal adult values.
Choice D reason: A blood pressure of 120/80 mmHg is considered normal for adults, per current guidelines like those from the American Heart Association. It reflects balanced systolic and diastolic pressures, indicating healthy cardiovascular function without signs of hypertension or hypotension, making it the correct choice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Clear bilateral lung sounds are a normal respiratory finding, indicating unobstructed airways and effective gas exchange. Abnormal sounds like wheezing or crackles would suggest pathology, but this choice reflects expected lung function, not an unexpected assessment outcome.
Choice B reason: Absence of cough is a normal finding, suggesting no airway irritation or obstruction. Coughing may indicate infection or fluid accumulation, but its absence aligns with healthy respiratory status, making this a typical and expected assessment result.
Choice C reason: Using an incentive spirometer post-surgery is an expected finding, as it promotes lung expansion and prevents atelectasis. It indicates patient compliance with respiratory therapy, a standard post-operative intervention, not an abnormal or unexpected respiratory assessment outcome.
Choice D reason: An oxygen saturation of 90% on 2 liters of oxygen via nasal cannula is unexpected, as normal saturation should be 95-100%. This suggests hypoxemia, potentially from lung pathology or inadequate oxygen delivery, warranting further investigation, making it the correct choice.
Correct Answer is B
Explanation
Choice A reason: A heart rate below normal (e.g., <60 bpm) indicates bradycardia, not necessarily arrhythmia, which is characterized by irregular rhythm. Irregular heart rate defines arrhythmia. Assuming low rate risks misdiagnosis, potentially missing treatments like antiarrhythmics, critical for stabilizing rhythm and preventing complications in arrhythmic patients.
Choice B reason: Irregular heart rate is the hallmark of arrhythmia, reflecting disrupted electrical conduction (e.g., atrial fibrillation). This sign, detected via pulse or ECG, guides diagnosis and treatment like anticoagulants or cardioversion. Accurate identification ensures timely intervention, critical for preventing stroke or heart failure in patients with cardiac rhythm disturbances.
Choice C reason: Low respiratory rate is unrelated to arrhythmia, which affects heart rhythm, not breathing. Irregular heart rate is the key sign. Assuming respiratory rate misdirects focus, risking neglect of cardiac monitoring or treatment, potentially delaying management of arrhythmia and increasing risks of thromboembolism or hemodynamic instability.
Choice D reason: Decreased blood pressure upon standing (orthostatic hypotension) is unrelated to arrhythmia, which involves irregular heart rhythm. Misidentifying this risks overlooking cardiac signs like irregular pulse, delaying ECG or antiarrhythmic therapy, critical for managing arrhythmia and preventing complications like syncope or heart failure in affected patients.
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