When measuring the heart rate, which of the following is most important?
Always use a doppler ultrasound to detect the heart rate
Count the beats for 60 seconds if the rhythm is irregular
Count the beats for 15 seconds and multiply by 4
Count the beats for 30 seconds and multiply by 3
The Correct Answer is B
Rationale:
A. Using a doppler ultrasound is not always necessary for measuring heart rate. While it can be helpful for weak or difficult-to-palpate pulses, most heart rates can be accurately assessed by palpation at peripheral sites (e.g., radial pulse) or auscultation. This is not the most important principle for accurate heart rate measurement.
B. Counting the beats for 60 seconds is the most accurate method when the rhythm is irregular. Irregular rhythms, such as in atrial fibrillation or arrhythmias, can lead to miscalculations if shorter counting periods are used. A full 60-second count ensures accuracy in rate assessment and provides reliable data for clinical decision-making.
C. Counting for 15 seconds and multiplying by 4 is acceptable only for regular rhythms, as it assumes the rhythm is consistent. For irregular rhythms, this method may lead to significant errors in calculating the true heart rate.
D. Counting for 30 seconds and multiplying by 2 or 3 (in some methods) is also acceptable for regular rhythms but, like the 15-second method, may produce inaccurate results with irregular heartbeats.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.8"]
Explanation
Step 1: Identify desired dose and concentration
Desired dose = 30 mg, Concentration = 40 mg/mL
Step 2: Use the formula
Volume (mL) = Desired dose ÷ Concentration
Step 3: Insert values
= 30 ÷ 40
Step 4: Calculate
= 0.75 mL
Step 5: Round to the nearest tenth
≈ 0.8 mL
Final Answer: 0.8
Correct Answer is D
Explanation
Rationale:
A. Saying "You're probably overthinking it. There's no need to be so anxious" is incorrect because it minimizes the patient's feelings and can make the patient feel dismissed. Therapeutic communication requires validation, not judgment.
B. Saying "It's normal to feel that way, but it's probably nothing serious. Let's focus on the assessment" is incorrect because it assumes the situation is not serious and does not address the patient’s emotional needs. This approach can reduce trust and increase anxiety.
C. Saying "Don't worry. The tests will show that everything is fine with your heart" is incorrect because it provides false reassurance. Premature reassurance without assessment is unsafe, especially when the patient is experiencing symptoms like shortness of breath and chest pain, which may indicate a cardiac emergency.
D. Saying "I understand your concern. Let's talk about what you're feeling, and I'll explain what we're doing to assess your heart" is correct. This response acknowledges the patient’s feelings, encourages expression of concerns, and provides information about the plan of care. It uses therapeutic communication by combining empathy, active listening, and patient education, which helps reduce anxiety and promotes trust.
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