Because the older adult's blood vessels are nonelastic, they are prone to orthostatic hypotension. A priority intervention for a patient with orthostatic hypotension is to:

allow the patient to sit on the side of the bed for a minute before standing.

instruct the patient to use the wheelchair for all mobility activity.

keep the patient in bed in a high Fowler's position

help the patient to rise quickly and support the patient for a minute.

Answer and Explanation

The Correct Answer is A

A.   Allowing the patient to sit on the side of the bed helps to prevent sudden drops in blood pressure and allows the body to adjust to the change in position, reducing the risk of fainting or dizziness.
B.   Using a wheelchair for mobility may not address the root cause of orthostatic hypotension and may limit the patient's independence.
C.   Keeping the patient in a high Fowler's position could worsen the symptoms of orthostatic hypotension.
D.   Rising quickly could lead to a sudden drop in blood pressure and increase the risk of a fall or injury.

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Correct Answer is A

Explanation

A. Listening to the apical pulse for one full minute provides a more accurate reading of the heart rate and rhythm, especially when the radial pulse is irregular.
B. Recording the findings on the graphic sheet is necessary, but it doesn’t address the irregularity of the pulse.
C. Taking the pulse on the other wrist does not provide the necessary information about the apical pulse.
D. Taking the pulse for one full minute on the other wrist is not necessary unless the pulse is absent on the first wrist.

A. inspection of the extremities. B. auscultation of the lungs. C. percussion of the flank areas of the back. D. auscultation of bowel sounds.

Correct Answer is C

Explanation

A. While extremity inspection is important, it is not as directly related to assessing back pain as evaluating the back itself.

B. Auscultating the lungs is essential in respiratory assessments but is not the priority when examining a patient with back pain.
C. Percussion of the flank areas is a key part of the physical examination for back pain, particularly if there are concerns of kidney involvement or other internal issues causing discomfort.
D. Bowel sounds are not directly related to back pain unless gastrointestinal issues are suspected.

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Because the older adult's blood vessels are nonelastic, they are prone to orthostatic hypotension. A priority intervention for a patient with orthostatic hypotension is to:

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a patient with a cardiac disease history. When measuring vital signs, the nurse finds that the radial pulse is 102 beats/min and irregular. The nurse correctly:

Correct Answer is A

Explanation

A very pertinent part of the physical examination on a patient with back pain is

Correct Answer is C

Explanation

A nurse caring for a patient on bed rest with a history of respiratory health problems should:

A nurse is checking a client's bowel sounds. At which of the following times should the nurse auscultate the client's abdomen?

The nurse covers a newborn baby's head with a cap. because the head:

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If a silence is heard between sounds when auscultating blood pressure, it is termed a(n)