A nurse is preparing to assess a patient for postural BP changes. Which of
the following indicates the need for further education?
You Selected:
Letting 30 seconds elapse after each position change before measuring
...
A nurse is preparing to assess a patient for postural BP changes. Which of
the following indicates the need for further education?
You Selected:
Letting 30 seconds elapse after each position change before measuring BP
and heart rate (HR)
Correct response:
Letting 30 seconds elapse after each position change before measuring BP
and heart rate (HR)
Explanation:
The following steps are recommended when assessing patients for postural
hypotension: Position the patient supine for 10 minutes before taking the
initial BP and HR measurements; reposition the patient to a sitting position
with legs in the dependent position, wait 2 minutes then reassess both BP
and HR measurements; if the patient is symptom free or has no significant
decreases in systolic or diastolic BP, assist the patient into a standing
position, obtain measurements immediately and recheck in 2 minutes;
continue measurements every 2 minutes for a total of 10 minutes to rule out
postural hypotension. Return the patient to supine position if postural
hypotension is detected or if the patient becomes symptomatic. Document
HR and BP measured in each position (e.g., supine, sitting, and standing) and
any signs or symptoms that accompany the postural changes.
Question 5 See full question
You are working on a telemetry unit. Your client was admitted with a cardiac
event and is now on a cardiac monitor. You know a cardiac monitor reveals
the heart's electrical but not its mechanical activity. How would you assess
the mechanical activity of the client's heart?
You Selected:
Palpate a peripheral pulse.
Correct response:
Palpate a peripheral pulse.
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