nurse is caring for a client who has a tracheostomy and requires suctioning. Identify the sequence of steps the nurse should follow after applying sterile gloves. (Move the steps, placing them in the selected order of performance. Use all the steps.)

A. Apply the largest cuff available: Using an inappropriately large cuff can lead to inaccurate blood pressure readings, often underestimating the true values. The cuff size should be proportional to the client’s arm circumference, not simply the largest available.

B. Use the palpatory method to determine blood pressure: When Korotkoff sounds are difficult to auscultate, the nurse can use the palpatory method to estimate systolic pressure. This involves palpating the radial or brachial pulse while inflating the cuff and noting when the pulse disappears and reappears, providing a reliable alternative for measuring blood pressure.

C. Place the arm above the level of the client's heart: Positioning the arm above heart level can artificially lower the measured blood pressure due to hydrostatic effects. Proper technique requires the arm to be at heart level for accurate assessment.

D. Deflate the cuff quickly: Rapid deflation can cause missed Korotkoff sounds and inaccurate readings. The cuff should be deflated slowly, at a rate of 2–3 mm Hg per second, to ensure correct auscultation of both systolic and diastolic pressures.

A. Schedule nursing staff training for infection control procedures: While staff education is essential to prevent catheter-associated infections, initiating training before identifying specific contributing factors may not address the root cause. Education should be targeted based on identified needs.

B. Revise the current policy for catheter care: Policy revision can improve compliance and standardization of care, but changing protocols without understanding why infections have increased may be ineffective or unnecessary.

C. Identify possible precipitating factors related to the infections: The first step in quality improvement is to assess and identify the underlying causes of the problem. Determining precipitating factors allows the facility to implement targeted interventions that effectively reduce catheter-associated infections.

D. Meet with providers to discuss measures to decrease the infections: Collaboration with providers is important for multidisciplinary interventions, but this should occur after identifying factors contributing to the increase in infections to ensure discussions are evidence-based and focused.