When assessing the blood pressure of a school-aged child, using an adult cuff of normal size will affect the reading and produce a value that is
falsely low
indistinct
accurate
falsely high
The Correct Answer is A
A. Falsely low. Using an adult-sized cuff on a child results in an overestimation of the cuff size, causing the cuff to not inflate properly and distribute less pressure, leading to a falsely low blood pressure reading.
B. Indistinct. The reading may be inaccurate, but it will still produce a numerical value rather than being completely indistinct.
C. Accurate. Accuracy depends on using a cuff size appropriate for the child's arm circumference. An adult cuff on a child is too large, leading to an incorrect reading.
D. Falsely high. A too-small cuff would produce a falsely high reading, but an oversized cuff produces a falsely low blood pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Ask the client to take deep breaths. Deep breathing can help relax the anal sphincter, but if resistance is already encountered, forcing the thermometer further could cause injury.
B. Remove the thermometer and reinsert more forcefully. Forcing the thermometer can cause damage to the rectal mucosa, leading to pain, bleeding, or even perforation.
C. Apply mild pressure to advance. Any resistance suggests a possible obstruction, such as stool or anatomical issues. Applying pressure could cause harm, so the thermometer should not be advanced further.
D. Remove the thermometer immediately. If resistance is encountered, the safest action is to withdraw the thermometer to prevent injury. The nurse should reassess the situation and consider alternative temperature measurement methods.
Correct Answer is C
Explanation
A. Bradypnea refers to an abnormally slow respiratory rate, typically below 12 breaths per minute in an adult. A rate of 32 breaths/min is too fast to be considered bradypnea.
B. Apnea is the absence of breathing for a prolonged period. Since the patient has a respiratory rate of 32 breaths/min, apnea does not apply.
C. Tachypnea is defined as a rapid respiratory rate exceeding 20 breaths per minute in an adult. A rate of 32 breaths/min indicates tachypnea, which may be caused by conditions such as fever, anxiety, or respiratory distress.
D. Eupnea refers to normal breathing, with a respiratory rate between 12–20 breaths per minute. A rate of 32 breaths/min is too high to be considered eupnea.
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