Question

A nurse is assessing four adult clients. Which of the following physical assessment techniques should the nurse use?

A) Ensure the bladder of the blood pressure cuff surrounds 80% of the client's arm (Correct)
B) Place the stethoscope's diaphragm on the client's skin for lung sounds
C) Use a blood pressure cuff on the client's leg for accurate readings
D) Measure the client's respiratory rate immediately after physical activity

Answer 1

A nurse should ensure the blood pressure cuff surrounds 80% of the client's arm for accurate blood pressure measurement using a sphygmomanometer, involving an inflatable cuff, rubber pump, and stethoscope for Korotkoff sounds.

Step-by-step explanation:

The nurse should use the following physical assessment technique: ensure that the bladder of the blood pressure cuff surrounds 80% of the client's arm. This ensures an accurate measurement by providing even pressure around the upper arm and proper alignment with the brachial artery. The blood pressure is measured using a sphygmomanometer, which involves tightening an inflatable cuff around the patient's arm at heart level, inflating the cuff with a rubber pump, and listening for Korotkoff sounds with a stethoscope placed on the patient's antecubital region to determine systolic and diastolic pressures. It is important for the blood pressure cuff to be sized appropriately for the patient to ensure accurate readings. Listening for lung sounds with the stethoscope's diaphragm placed on the client's skin is also appropriate, but it is unrelated to blood pressure measurement.