A registered nurse is teaching a nursing student about when a client with high blood pressure

Q: When assessing the patients respiration for which reason would the nurse elevate the bed to 60 degrees in a sitting position?

When assessing the patients respiration, the nurse elevates the bed to 60 degrees in a sitting position. What is the rationale behind this intervention? Sitting erect promotes full ventilatory movement and ensures a clear view of the chest wall and abdominal movements.

The nurse assesses a client for orthostatic hypotension. The results are:

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In which phase would the nurse observe blowing and whooshing sounds during blood pressure?
Which nursing intervention for opening the airway should be performed in an unconscious client with a spinal injury?
Which step should the nurse take to alert the risk management system after notifying the primary health care provider of a client's fall?
When assessing the patient's respiration for which reason would the nurse elevate the bed to 60 degrees in a sitting position?

Lying heart rate = 70 beats/minute, BP = 110/70;
Sitting heart rate = 78 beats/minute, BP = 106/66;
Standing heart rate = 85 beats/minute, BP = 100/64.
The nurse would expect which prescription from the primary healthcare provider?

A)
No prescription change

B)
Start intravenous (IV) infusion of D5 ½ NS to run at 150 mL/hr

C)
Give 1 L of 0.9% normal saline (NS) bolus over 4 hours

D)
Increase furosemide from 20 mg by mouth (PO) to 40 mg PO daily

In which phase would the nurse observe blowing and whooshing sounds during blood pressure?

Phase 2: A swishing/whooshing sound. Swishing sounds as the blood flows through blood vessels as the cuff is deflated.

Which nursing intervention for opening the airway should be performed in an unconscious client with a spinal injury?

If you think the person may have a spinal injury, place your hands on either side of their head and use your fingertips to gently lift the angle of the jaw forward and upwards, without moving the head, to open the airway. Take care not to move the person's neck.

Which step should the nurse take to alert the risk management system after notifying the primary health care provider of a client's fall?

The nurse taking care of the client informs the primary healthcare provider. What step should the nurse take to alert the risk management system? The nurse should document the incident in the occurrence report tool.

When assessing the patient's respiration for which reason would the nurse elevate the bed to 60 degrees in a sitting position?

When assessing the patient's respiration, the nurse elevates the bed to 60 degrees in a sitting position. What is the rationale behind this intervention? Sitting erect promotes full ventilatory movement and ensures a clear view of the chest wall and abdominal movements.

A registered nurse is teaching a nursing student about when a client with high blood pressure

In which phase would the nurse observe blowing and whooshing sounds during blood pressure?

Which nursing intervention for opening the airway should be performed in an unconscious client with a spinal injury?

Which step should the nurse take to alert the risk management system after notifying the primary health care provider of a client's fall?

When assessing the patient's respiration for which reason would the nurse elevate the bed to 60 degrees in a sitting position?

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