The nursing assistive personnel (NAP) is taking vital signs and ...

[leilurhhh]

The nursing assistive personnel (NAP) is taking vital signs and reports that a patient's blood pressure is abnormally low. What should the nurse do next?
 
  a. Ask the NAP retake the blood pressure.
  b. Instruct the NAP to assess the patient's other vital signs.
  c. Disregard the report and have it rechecked at the next scheduled time.
  d. Retake the blood pressure personally and assess the patient's condition.

Question 2

A nurse is working in the intensive care unit and must obtain core temperatures on patients. Which sites can be used to obtain a core temperature? (Select all that apply.)
 
  a. Rectal
  b. Tympanic
  c. Esophagus
  d. Temporal artery
  e. Pulmonary artery

[Jbrasil]

Answer to Question 1

ANS: D
The nursing assistive personnel should report abnormalities to the nurse, who should further assess the patient. The nursing assistive personnel should not retake the blood pressure or other vital signs because the nurse needs to assess the patient. The report cannot be disregarded. Assessment must be done by the nurse.

Answer to Question 2

ANS: B, C, E
Intensive care units use the core temperatures of the pulmonary artery, esophagus, and urinary bladder. Because the tympanic membrane shares the same arterial blood supply as the hypothalamus, the tympanic temperature is a core temperature. Temporal artery measurements detect the temperature of cutaneous blood flow. Oral, rectal, axillary, and skin temperature sites rely on effective blood circulation at the measurement site.

[leilurhhh]

Excellent

[aliotak]

Gracias!