100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
logo-home
Previously searched by you
Previously searched by you
logo
NSG 3100 Exam 2 Questions with complete solution $13.49   Add to cart
Quickly navigate to
Preview
  2.  
  3. NSG 3100
  4.  
  5. NSG 3100

Exam (elaborations)

NSG 3100 Exam 2 Questions with complete solution

 0 view  0 purchase
  • Course
  • NSG 3100
  • Institution
  • NSG 3100

NSG 3100 Exam 2 Questions with complete solution NSG 3100 Exam 2 The client's temperature at 8:00 am using an oral electronic thermometer is 36.1°C (97.2°F). If the respiration, pulse, and blood pressure were within normal range, what would the nurse do next? 1. Wait 15 minutes and retake i...

[Show more]

Preview 3 out of 16  pages

Document information

  • October 26, 2024
  • 16
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

Subjects

Written for

  • NSG 3100
  • NSG 3100

Seller

avatar-seller
Carzola98

Reviews received

Content preview

NSG 3100 Exam 2
The client's temperature at 8:00 am using an oral electronic thermometer is
36.1°C (97.2°F). If the respiration, pulse, and blood pressure were within
normal range, what would the nurse do next?
1. Wait 15 minutes and retake it.
2. Check what the client's temperature was the last time it was taken.
3. Retake it using a different thermometer.
4. Chart the temperature; it is normal - correct answer ✔Answer: 2.
Rationale: Although the temperature is slightly lower than expected for the
morning, it would be best to determine the client's previous temperature range
next. This may be a normal range for this client. Depending on that finding,
the nurse might want to retake it in a few minutes—no need to wait 15
minutes (option 3) or with another
thermometer to see if the initial thermometer was functioning properly. Chart
after determining that the temperature has been measured properly (option 4).
Cognitive Level: Applying. Client Need: Health Maintenance and Promotion.
Nursing Process: Assessment. Learning Outcome: 29-4.


Which client meets the criteria for selection of the apical site for assessment
of the pulse rather than a radial pulse?
1. A client who is in shock
2. A client whose pulse changes with body position changes
3. A client with an arrhythmia
4. A client who had surgery less than 24 hours ago - correct answer
✔Answer: 3. Rationale: The apical rate would confirm the rate and determine
the actual cardiac rhythm for a client with an abnormal rhythm; a radial pulse
would only reveal the heart rate and suggest an arrhythmia. For clients in
shock, use the carotid or femoral pulse (option 1). The radial pulse is
adequate for determining a change in the orthostatic heart rate (option 2). The
radial pulse is appropriate for routine postoperative vital sign checks for clients
with regular pulses (option 4). Cognitive Level: Understanding. Client Need:

,Health Promotion and Maintenance. Nursing Process: Planning. Learning
Outcome: 29-5


When the nurse enters a client's room to measure routine vital signs, the client
is on the phone. What technique should the nurse use to determine the
respiratory rate?
1. Count the respirations during conversational pauses.
2. Ask the client to end the phone call now and resume it at a later time.
3. Wait at the client's bedside until the phone call is completed and then count
respirations.
4. Since there is no evidence of distress or urgency, postpone the
measurement until later. - correct answer ✔Answer: 4. Rationale: Since the
client's needs are always considered first, the measurement should be
delayed unless the client is in distress or there are other urgent reasons.
Option 1: Respirations should be measured for 30 seconds to 1 minute and
are affected by talking. Option 2: There needs to be an important reason for
interrupting the
client. Option 3: It is inappropriate to wait and listen to the client's
conversation. Cognitive Level: Understanding. Client Need: Health Promotion
and Maintenance. Nursing Process: Planning. Learning Outcome: 29-3d.


For a client with a previous blood pressure of 138/74 mmHg and pulse of 64
beats/min, approximately how long should the nurse take to release the blood
pressure cuff in order to obtain an accurate reading?
1. 10-20 seconds
2. 30-45 seconds
3. 1-1.5 minutes
4. 3-3.5 minutes - correct answer ✔Answer: 2. Rationale: If the cuff is
inflated to about 30 mmHg over previous systolic pressure, that would be 168.
To ensure that the diastolic
has been determined, the cuff should be released slowly until the mid60s
mmHg (and then completely) for someone with a previous reading

, of 74. The cuff should be deflated at a rate of 2 to 3 mm per second. Thus, a
range of 90 mmHg will require 30 to 45 seconds. Cognitive Level: Analyzing.
Client Need: Health Promotion and Maintenance. Nursing Process:
Implementation. Learning Outcome: 29-3e


It would be appropriate to delegate the taking of vital signs of which client to
unlicensed assistive personnel?
1. A client being prepared for elective facial surgery with a history of stable
hypertension
2. A client receiving a blood transfusion with a history of transfusion reactions
3. A client recently started on a new antiarrhythmic agent
4. A client who is admitted frequently with asthma attacks - correct answer
✔Answer: 1. Rationale: Vital signs measurement may be delegated to UAP if
the client is in stable condition, the findings are expected to be predictable,
and the technique requires no modification. Only the preoperative client meets
these requirements. In addition, UAP are not delegated to take apical pulse
measurements for the client with an irregular pulse as would be the case with
the client newly started on antiarrhythmic medication (option 3). Cognitive
Level: Applying. Client Need: Health Promotion and Maintenance. Nursing
Process: Planning. Learning Outcome: 29-8.


An 85-year-old client has had a stroke resulting in right-sided facial drooping,
difficulty swallowing, and the inability to move self or maintain position
unaided. The nurse determines that which sites are most appropriate for
taking the temperature?
Select all that apply.
1. Oral
2. Rectal
3. Axillary
4. Tympanic
5. Temporal artery - correct answer ✔Answer: 3, 4, and 5. Rationale: For this
client, the nurse could take an axillary, tympanic, or temporal artery

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

Quick and easy check-out

You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.

Focus on what matters

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

Frequently asked questions

What do I get when I buy this document?

You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.

Satisfaction guarantee: how does it work?

Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.

Who am I buying these notes from?

Stuvia is a marketplace, so you are not buying this document from us, but from seller Carzola98. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for $13.49. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

81633 documents were sold in the last 30 days

Founded in 2010, the go-to place to buy study notes for 14 years now

Start selling
$13.49
  • (0)
  Add to cart