The nurse needs to obtain a radial pulse from a patient. To obtain the correct measure, what must the nurse do?

Correct Answer: A

Rationale: The correct answer is A) Place the tips of the first two fingers over the groove along the thumb side of the patient's wrist. Rationale: 1. Correct Answer: Placing the first two fingers over the radial pulse site is key to accurately assess the pulse rate. This method ensures that the nurse is directly palpating the radial artery, which is essential for an accurate reading. 2. Incorrect Answer B: Placing the thumb over the pulse site is incorrect as the thumb has a stronger pulse of its own, which can interfere with the accuracy of the measurement. 3. Incorrect Answer C: Applying a very light touch to avoid obliterating the pulse is correct. However, the method of placing the first two fingers over the pulse site is crucial for an accurate reading. 4. Incorrect Answer D: Applying very strong pressure is incorrect as it can compress the artery, leading to an inaccurate measurement of the pulse rate. Educational Context: Proper assessment of vital signs, including pulse rate, is essential in healthcare to monitor a patient's health status. By correctly palpating the radial pulse, nurses can accurately determine the heart rate, rhythm, and overall cardiovascular function of the patient. It is crucial for nursing students to learn and practice the correct technique for obtaining radial pulses to provide safe and effective patient care.

Correct Answer: C

Rationale: The correct answer is C) Faces Pain Scale - Revised (FPS-R) for assessing pain in children who are too young to verbalize their pain intensity. The Faces Pain Scale - Revised uses a series of faces displaying varying expressions of pain, allowing children to point to the face that best represents their current level of pain. This scale is widely used in pediatric settings because it provides a visual representation that is easy for children to understand and communicate their pain levels effectively. Option A) Numeric Rating Scale (NRS) requires the child to verbally express their pain level using numbers, which may not be suitable for children who cannot articulate their pain intensity. Option B) Visual Analog Scale (VAS) involves marking on a line to indicate pain level, which may also be challenging for young children who lack the cognitive ability to understand and use this scale effectively. Option D) Wong-Baker FACES Pain Rating Scale is a similar tool to FPS-R but the Faces Pain Scale - Revised is more commonly used and validated in pediatric populations. In an educational context, it is crucial for healthcare professionals, especially nurses working with pediatric patients, to be familiar with appropriate pain assessment tools for children of different age groups. Understanding the nuances of each pain scale and its suitability for specific populations is essential for effective pain management in pediatric patients.

Correct Answer: D

Rationale: The correct answer is D) African American. African Americans are at the greatest risk for hypertension due to genetic predisposition, higher rates of obesity, and increased prevalence of other risk factors such as diabetes and kidney disease within this population. This group also tends to develop hypertension at a younger age and have more severe complications if left untreated. Option A) Hispanic individuals can also be at higher risk for hypertension, but statistically, African Americans have a higher prevalence. Option B) White individuals generally have a lower risk compared to African Americans. Option C) Asian individuals tend to have lower rates of hypertension compared to African Americans. In an educational context, understanding which populations are at greater risk for certain conditions, such as hypertension, is crucial for healthcare professionals to provide targeted and effective interventions. By recognizing the increased risk in African American individuals, healthcare providers can prioritize screenings, lifestyle interventions, and medication management to prevent and manage hypertension effectively in this population.

Correct Answer: C

Rationale: The most appropriate statement by the nurse in this scenario is option C: "Let me tell you what I will be doing. It should not be painful." This response is the best choice because it addresses the patient's anxiety by providing information and reassurance. Option A is incorrect because it dismisses the patient's feelings and may increase their anxiety by downplaying their concerns. Option B is also incorrect as it acknowledges potential pain without offering reassurance, which could heighten the patient's anxiety. Option D is incorrect as it does not address the patient's anxiety or provide any information to alleviate their concerns. In an educational context, it is crucial for healthcare professionals to communicate effectively with patients, especially when addressing their fears and anxieties. Providing clear explanations, reassurance, and involving the patient in their care can help build trust and cooperation, leading to better outcomes and patient satisfaction. This scenario highlights the importance of empathy, communication skills, and patient-centered care in nursing practice.

Correct Answer: B

Rationale: In a health assessment, documentation serves as a crucial tool for accurately capturing and communicating the patient's health status. The correct answer, B) to identify actual and potential health problems, is the most appropriate because thorough documentation allows healthcare providers to track changes in a patient's condition over time, identify trends, and detect any emerging health issues. This information is essential for creating effective care plans, monitoring progress, and ensuring patient safety. Option A, to identify the nurse's role in healthcare, while important, is not the primary purpose of documentation in a health assessment. The focus should be on the patient's health status rather than the nurse's role. Option C, to expand nursing knowledge and skills, is valuable but not the primary goal of documentation in a health assessment. While documentation can contribute to professional growth, its main purpose is to capture accurate patient data. Option D, to provide a basis for evidence-based nursing, is closely related to the correct answer but not as specific. Documentation does indeed support evidence-based practice by providing a foundation for decision-making, but its primary role in a health assessment is to accurately identify the patient's health problems. Educationally, understanding the importance of accurate documentation in health assessments is fundamental for nursing students and healthcare professionals. It ensures continuity of care, promotes effective communication among the healthcare team, and safeguards patients by facilitating timely interventions. By emphasizing the significance of meticulous documentation, educators can instill in students the critical role it plays in delivering high-quality patient care.