BSN 206 Hallmark Questions & Answers|
Grade A| 100% Correct (Verified Solutions)
2025/026
The clients BP reading is 150/80 mmHg. For this client, 80 is representative of:
1. The ventricles during contraction.
2. The systolic pressure.
3. The ventricles during relaxation.
4. The pulse pressure.
5. The diastolic pressure.
6. The pulse deficit. - ANSWER The ventricles during
relaxation
The diastolic pressure
The UAP reports to the nurse that the client's pulse oximetry is 88%. What
action(s) should the nurse take? (Select all that apply.)
1. Perform a cardiopulmonary assessment.
2. Notify the health care provider.
3. Verify the reading by taking the client's pulse oximetry.
4. Assist the client to a high-Fowler's position.
5. None should be taken because this is a normal value.
6. Assist the client to a fully supine position.
7. Be prepared to administer oxygen. - ANSWER Notify the
health care provider
Verify the reading by taking the client's pulse oximetry
Assist the client to a high-fowler's position
Be prepared to administer oxygen
Perform a cardiopulmonary assessment
The student nurse is assessing a client's pulses. What action by the student requires
the nurse to intervene?
,1. Assessing the radial pulse on the client's wrist
2. Assessing the brachial pulse on the client's inner elbow
3. Assessing apical pulse between the fifth and sixth intercostal spaces
4. Assessing the dorsalis pedis pulse by palpating behind the client's knee -
ANSWER Assessing the dorsalis pedis pulse by palpating behind
the client's knee
When taking an adult blood pressure, the onset of the sound the nurse hears is at
138, the muffled sound the nurse hears is at 70, and the disappearance of the sound
the nurse hears is at 62. How should the nurse record this finding?
1. 138/70
2. 68
3. 76
4. 138/62 - ANSWER 138/62
The nurse was assigned to care for five clients. Which of the following vital sign
measurements would be cause for concern? (Select all that apply.)
1. 22-year-old with heart rate of 90 beats/minute
2. 75-year-old with pulse oximetry of 88% on room air
3. 88-year-old with temperature of 96.8° F (36° F)
4. 8-year-old with respiratory rate of 24 breaths/minute - ANSWER
75 year old with pulse oximetry of 88% on room air
65 year old with blood pressure of 140/90
A nursing student is assigned to take the vital signs on a client and finds the radial
pulse to be irregular. What action should the nursing student take?
1. Auscultate the client's apical pulse.
2. Check the client's previous pulse reading.
3. Wait 15 minutes and reassess the pulse.
4. Ask a fellow student to assess the pulse. - ANSWER
Auscultate the clients apical pulse
,The nurse has applied a pulse oximeter to the finger of a client who is
hypothermic. The pulse oximeter does not provide a good reading. What action by
the nurse is best?
1. Document that the reading cannot be obtained.
2. Assess the fingers for good circulation.
3. Remove any fingernail polish present on the fingernail.
4. Move the oximeter probe to another finger. - ANSWER
Assess the fingers for good circulation
The nurse is performing a morning assessment and notes the client to be
experiencing dyspnea. Which client assessment findings would most indicate this
respiratory condition? (Select all that apply.)
1. Pulse oximetry 89%
2. Respirations 26 & shallow
3. Temperature 100.1 °F
4. Patient in orthopneic position
5. Occasional productive cough - ANSWER Pulse oximetry
89%
Respirations 26 and shallow
The nursing student learns that the purpose of measuring a client's vital signs
includes which of the following rationale? (Select all that apply.)
1. Provide a baseline to compare against.
Evaluate effectiveness of interventions.
Monitor body systems functioning.
Determine if a cure has been obtained.
Identify early signs of problems. - ANSWER Provide a
baseline to compare against
evaluate effectiveness of interventions
Monitor body system functioning
identify early signs of problems
, A client is experiencing pyrexia. Which piece of equipment will the nurse obtain to
monitor this condition?
1. sphygomomanometer
2. pulse oximeter
3. blood pressure cuff
4. thermometer
5. stethoscope - ANSWER Thermometer
Which of the following should the nurse report to the health care provider?
1.A young adult with a blood pressure of 110/70.
2.An elderly male with a temperature of 96.8°F (36°C).
3.An adult client with a heart rate of 55.
4.A newborn with a respiratory rate of 40. - ANSWER An
adult client with a heart rate of 55
The nurse caring for a 30-year-old post-surgical client would assess that they are in
pain as indicated by:
1.blood pressure of 128/86 mm Hg.
2.a temperature of 102° F.
3. respirations of 16 breaths/min.
4.a pulse rate of 120 beats/min - ANSWER A pulse rate of
120 beats per min
A nurse is caring for a client with a cardiac disease history. When measuring vital
signs, the nurse finds that the radial pulse is 102 beats/minute and irregular. The
nurse correctly:
1.listens to the apical pulse for 1 full minute.
2.takes the pulse for 1 full minute on the other wrist.
3.takes the pulse for 30 seconds on the other wrist.
4.records the findings on the graphic sheet. - ANSWER listens
to apical pulse for 1 full minute
Grade A| 100% Correct (Verified Solutions)
2025/026
The clients BP reading is 150/80 mmHg. For this client, 80 is representative of:
1. The ventricles during contraction.
2. The systolic pressure.
3. The ventricles during relaxation.
4. The pulse pressure.
5. The diastolic pressure.
6. The pulse deficit. - ANSWER The ventricles during
relaxation
The diastolic pressure
The UAP reports to the nurse that the client's pulse oximetry is 88%. What
action(s) should the nurse take? (Select all that apply.)
1. Perform a cardiopulmonary assessment.
2. Notify the health care provider.
3. Verify the reading by taking the client's pulse oximetry.
4. Assist the client to a high-Fowler's position.
5. None should be taken because this is a normal value.
6. Assist the client to a fully supine position.
7. Be prepared to administer oxygen. - ANSWER Notify the
health care provider
Verify the reading by taking the client's pulse oximetry
Assist the client to a high-fowler's position
Be prepared to administer oxygen
Perform a cardiopulmonary assessment
The student nurse is assessing a client's pulses. What action by the student requires
the nurse to intervene?
,1. Assessing the radial pulse on the client's wrist
2. Assessing the brachial pulse on the client's inner elbow
3. Assessing apical pulse between the fifth and sixth intercostal spaces
4. Assessing the dorsalis pedis pulse by palpating behind the client's knee -
ANSWER Assessing the dorsalis pedis pulse by palpating behind
the client's knee
When taking an adult blood pressure, the onset of the sound the nurse hears is at
138, the muffled sound the nurse hears is at 70, and the disappearance of the sound
the nurse hears is at 62. How should the nurse record this finding?
1. 138/70
2. 68
3. 76
4. 138/62 - ANSWER 138/62
The nurse was assigned to care for five clients. Which of the following vital sign
measurements would be cause for concern? (Select all that apply.)
1. 22-year-old with heart rate of 90 beats/minute
2. 75-year-old with pulse oximetry of 88% on room air
3. 88-year-old with temperature of 96.8° F (36° F)
4. 8-year-old with respiratory rate of 24 breaths/minute - ANSWER
75 year old with pulse oximetry of 88% on room air
65 year old with blood pressure of 140/90
A nursing student is assigned to take the vital signs on a client and finds the radial
pulse to be irregular. What action should the nursing student take?
1. Auscultate the client's apical pulse.
2. Check the client's previous pulse reading.
3. Wait 15 minutes and reassess the pulse.
4. Ask a fellow student to assess the pulse. - ANSWER
Auscultate the clients apical pulse
,The nurse has applied a pulse oximeter to the finger of a client who is
hypothermic. The pulse oximeter does not provide a good reading. What action by
the nurse is best?
1. Document that the reading cannot be obtained.
2. Assess the fingers for good circulation.
3. Remove any fingernail polish present on the fingernail.
4. Move the oximeter probe to another finger. - ANSWER
Assess the fingers for good circulation
The nurse is performing a morning assessment and notes the client to be
experiencing dyspnea. Which client assessment findings would most indicate this
respiratory condition? (Select all that apply.)
1. Pulse oximetry 89%
2. Respirations 26 & shallow
3. Temperature 100.1 °F
4. Patient in orthopneic position
5. Occasional productive cough - ANSWER Pulse oximetry
89%
Respirations 26 and shallow
The nursing student learns that the purpose of measuring a client's vital signs
includes which of the following rationale? (Select all that apply.)
1. Provide a baseline to compare against.
Evaluate effectiveness of interventions.
Monitor body systems functioning.
Determine if a cure has been obtained.
Identify early signs of problems. - ANSWER Provide a
baseline to compare against
evaluate effectiveness of interventions
Monitor body system functioning
identify early signs of problems
, A client is experiencing pyrexia. Which piece of equipment will the nurse obtain to
monitor this condition?
1. sphygomomanometer
2. pulse oximeter
3. blood pressure cuff
4. thermometer
5. stethoscope - ANSWER Thermometer
Which of the following should the nurse report to the health care provider?
1.A young adult with a blood pressure of 110/70.
2.An elderly male with a temperature of 96.8°F (36°C).
3.An adult client with a heart rate of 55.
4.A newborn with a respiratory rate of 40. - ANSWER An
adult client with a heart rate of 55
The nurse caring for a 30-year-old post-surgical client would assess that they are in
pain as indicated by:
1.blood pressure of 128/86 mm Hg.
2.a temperature of 102° F.
3. respirations of 16 breaths/min.
4.a pulse rate of 120 beats/min - ANSWER A pulse rate of
120 beats per min
A nurse is caring for a client with a cardiac disease history. When measuring vital
signs, the nurse finds that the radial pulse is 102 beats/minute and irregular. The
nurse correctly:
1.listens to the apical pulse for 1 full minute.
2.takes the pulse for 1 full minute on the other wrist.
3.takes the pulse for 30 seconds on the other wrist.
4.records the findings on the graphic sheet. - ANSWER listens
to apical pulse for 1 full minute
