What is the most appropriate action for the nurse to take when a ...

[gonzo233]

What is the most appropriate action for the nurse to take when a crying toddler has a blood pressure measurement of 120/70 mm Hg?
 
  a. Notify the physician of the measurement.
  b. Document the blood pressure reading and check it again in 4 hours.
  c. Quiet the child and retake the blood pressure.
  d. Ask the parent if the child has a history of hypertension.

Question 2

Which is the most appropriate site for the nurse to use to measure a pulse rate on a 1-year-old child?
 
  a. Apical
  b. Radial
  c. Carotid
  d. Femoral

[janeli1]

Answer to Question 1

C
Blood pressure is elevated when a child is upset and crying. Quieting the child before retaking the blood pressure is appropriate. Notifying the physician is not necessary until accurate data are obtained. Documenting the blood pressure and waiting 4 hours before taking another measurement is inappropriate because this reading is not within the normal range. Asking the parent about a history of hypertension is irrelevant when a child is upset and crying as blood pressure is elevated.

Answer to Question 2

A
Apical pulse rates are taken in children younger than 2 years. Radial pulse rates may be taken in children older than 2 years. It is difficult to palpate the carotid pulse in an infant. The femoral pulse is palpated when comparing peripheral pulses, but it is not used to measure an infant's pulse rate.

[gonzo233]

TYSM

[sailorcrescent]

Gracias!