ATI LPN
Fundamentals of Nursing: The Art and Science of Person-Centered Care Tenth, North American Edition
Chapter 29 : Complementary and Integrative Health Questions
Question 1 of 5
The patient wants to monitor blood pressure at home and asks the nurse's advice about how to purchase a portable electronic blood pressure device. Which other information will the nurse share with the patient?
Correct Answer: B
Rationale: Portable BP devices require recalibration (
B) for accuracy, a key teaching point. Random cuff placement (
A) or arm movement (
C) skews readings. Stethoscopes (
D) aren't needed for electronic devices.
Choice B is correct, ensuring reliable home monitoring per nursing education.
Question 2 of 5
The nurse is caring for a patient who reports feeling light-headed and 'woozy.' The nurse checks the patient's pulse and finds that it is irregular. The patient's blood pressure is 100/72. It was 113/80 an hour earlier. What should the nurse do?
Correct Answer: B
Rationale: Light-headedness, irregular pulse, and a BP drop (100/72 from 113/80) suggest instability (e.g., arrhythmia). Notifying the provider (
B) ensures prompt evaluation. More pressure (
A) won't clarify irregularity. Dismissing symptoms (
C) or delaying (
D) risks deterioration.
Choice B is correct, per nursing escalation protocols.
Question 3 of 5
A nurse is caring for a group of patients on a medical-surgical unit. Which patient will the nurse assess first?
Correct Answer: B
Rationale: A postoperative BP drop from 128/70 to 100/60 (
B) indicates potential shock or bleeding, a priority. Smoking (
A) or pain with stable BP (
C) is less urgent. Hypothermia (
D) needs attention but lacks acuity data.
Choice B is correct, per triage urgency in surgical care.
Question 4 of 5
After taking the patient's temperature, the nurse documents the value and the route used to obtain the reading. What is the reason for the nurse's action?
Correct Answer: A
Rationale: Temperature varies by route (
A) e.g., rectal is 1?°F higher, axillary 1?°F lower than oral requiring documentation for accuracy. Not all are core (
B). Rectal is warmer (C incorrect). Axillary is lower (D incorrect).
Choice A is correct, per nursing documentation standards.
Question 5 of 5
When taking an adult blood pressure, the onset of the sound the nurse hears is at 138, the muffled sound the nurse hears is at 70, and the disappearance of the sound the nurse hears is at 62. How should the nurse record this?
Correct Answer: B
Rationale: BP is recorded as systolic (onset, 138) over diastolic (disappearance, 62), so 138/62 (
B). Muffling (70) is phase IV, not standard for adults. 138/70 (
A) uses muffling incorrectly. 70/62 (
C) is invalid. 138/70/62 (
D) isn't standard.
Choice B is correct, per AHA guidelines.