Diabetic retinopathy Question 31 1 pts
Angus is a 46 y/o farmer who comes to the clinic for his annual physical exam. During the eye exam the NP notices that Angus has micro aneurysms and cotton wool spots on the retina. Based on these findings alone the NP could make the diagnosis that Angus has:
Group of answer choices
Papilledema
Hypertensive retinopathy
Diabetic retinopathy
Cataracts
Question 30 1 pts
A 19-year-old has fever, severe sore throat, odynophagia, and tender submandibular nodes. The most likely organism is:
Group of answer choices
Streptococcus pyogenes
Streptococcus pneumonia
Streptococcus mutans
Streptomyces
Question 29 1 pts
A patient has a localized nodule on one eyelid which is warm, tender, and erythematous. On examination, the provider notes clear conjunctivae and no discharge. What is the recommended treatment?
Group of answer choices
Referral to an ophthalmologist
Surgical incision and drainage
Systemic antibiotics
Warm compresses and massage of the lesion
Essay Assignment Help Free
The modern academic landscape is defined by a serious demand for excellence, precision, and original thought. For students facing the complexities of higher education, the pressure to produce high-quality papers under tight deadlines can be overwhelming. This has led to a massive surge in searches for “essay assignment help free.” While the digital world is flooded with automated tools and promises of cost-free assistance, discerning students know that quality often requires a professional touch. Among the myriad of options available,
Online Nursing Papers
stands out as the premier destination for students seeking specialized, high-authority academic support that is human-written and not AI-generated.
Essay Assignment Help Free Online
In 2026, the internet is the first port of call for any student struggling with a complex prompt. The term “essay assignment help free online” encompasses everything from peer-review forums and academic blogs to open-access databases. These resources are invaluable for brainstorming and structuring initial thoughts. However, the limitation of free online help is the lack of personalization. Most free platforms offer generic advice that does not account for specific grading rubrics or institutional requirements.
This is where
Online Nursing Papers
bridges the gap. While they provide premium, bespoke services, their online resource center offers foundational guidance that helps students understand the nuances of academic writing. By visiting their
Services Page
, students can see the breadth of expertise available, ensuring that their online search for help leads to a verified, professional outcome rather than a dead-end template.
ORDER HUMAN-WRITTEN PAPER HERE
Essay Assignment Help Free Download
Many students seek “essay assignment help free download” options, looking for templates, sample papers, or style guides that they can use as a blueprint. In 2026, downloadable resources have become more sophisticated, often including interactive outlines and citation checklists. These tools are excellent for setting the stage, but they cannot replace the critical thinking required for a top-tier essay.
Online Nursing Papers
provides high-quality samples and guides that serve as a gold standard for what an academic paper should look like. Utilizing their
Blog and Resource Section
allows students to download knowledge and insights from experts who understand the current 2026 academic standards. This ensures that even when you are looking for free structural help, the information is grounded in professional reality.
College Essay Assignment Help Free
College life is a balancing act of social obligations, part-time work, and intensive study. The search for “college essay assignment help free” is often driven by a need for time management. College-level writing requires a transition from descriptive writing to analytical and argumentative discourse. Many university writing centers offer free tutoring, but these are often overbooked and limited in their scope.
For students who need more than just a quick proofread,
Online Nursing Papers
offers specialized assistance that caters to the specific rigors of college-level nursing and healthcare curricula. Their experts are familiar with the 2026 standards for evidence-based practice and clinical reasoning, making them a more reliable partner than a generic campus writing center.
Academic Essay Assignment Help Free
“Academic essay assignment help free” usually refers to assistance with advanced research papers, case studies, and dissertations. At this level, the stakes are higher, and the need for credible sources is paramount. While open-access journals like
PubMed
provide free data, synthesizing that data into a coherent academic argument is the real challenge.
Professional services like
Online Nursing Papers
specialize in this synthesis. They offer a level of academic rigor that free tools simply cannot match. By employing writers with advanced degrees, they ensure that every essay is not only grammatically correct but also intellectually robust and compliant with the latest 2026 academic conventions.
AI Essay Writer Free
The rise of “AI essay writer free” tools has revolutionized how students approach the first draft. In 2026, AI tools can generate thousands of words in seconds. However, these tools often struggle with “hallucinations”—fabricating facts or citations—and they frequently lack the empathetic “human touch” required in fields like nursing and social sciences.
While an AI can provide a skeleton,
Online Nursing Papers
provides the soul. Using an AI tool to generate a free draft might save time initially, but it often leads to more work during the editing phase to ensure accuracy. The experts at Online Nursing Papers can take a rough AI-generated concept and refine it into a professional, submission-ready document.
ChatGPT Essay Writer Free
As of 2026, “ChatGPT essay writer free” remains one of the most popular searches. ChatGPT is an excellent brainstorming partner and can help students overcome writer’s block. It can suggest titles, outline chapters, and explain complex concepts in simple terms. However, most universities have implemented advanced AI detection software.
To avoid the pitfalls of academic dishonesty or technical errors associated with AI, students should use ChatGPT as a starting point and then turn to
Online Nursing Papers
for professional polishing. Their human writers ensure that the final product is original, properly cited, and passes all 2026 plagiarism and AI-detection scans.
Free Essay Generator
A “free essay generator” is often a “spinbot” or a basic algorithm that rephrases existing content. In the current academic climate, these generators are highly risky. They often produce nonsensical sentences and fail to grasp the context of the assignment. For a student in 2026, relying on a free generator can lead to failing grades or disciplinary action.
Instead of gambling with an automated generator, students are encouraged to consult the professional writers at
Online Nursing Papers
. Unlike a generator, their writers understand the “why” behind the prompt, ensuring that the essay addresses the core requirements of the rubric with precision and depth.
Human Essay Writer Free
While “human essay writer free” sounds like an oxymoron, it typically refers to peer-to-peer help or pro-bono tutoring services. While these can be helpful, they lack the accountability and expertise of a dedicated service. A peer might be able to spot a typo, but they may not understand the intricacies of APA 7th edition or the specific requirements of a 2026 nursing board.
Online Nursing Papers
employs human writers who are subject matter experts. They provide a level of mentorship and quality assurance that “free” human help cannot provide. When you
Place an Order
, you are investing in a human connection that ensures your academic success and peace of mind.
Why Online Nursing Papers is the Best Choice in 2026
In a world where “free” often means “low quality” or “high risk,”
Online Nursing Papers
offers a premium alternative that guarantees results. Whether you are looking for help with a simple reflection paper or a complex clinical analysis, their team provides:
Specialized Expertise:
Deep knowledge of nursing and healthcare fields.
Originality:
100% human-written content that passes all 2026 detection tools.
Timely Delivery:
Meeting even the most aggressive deadlines.
Professional Formatting:
Mastery of APA, MLA, and Chicago styles.
For students who want to ensure their academic career remains on track in 2026, the choice is clear. Don’t settle for the limitations of “free” when you can have the excellence of
Online Nursing Papers
. Visit their website today to experience the difference that professional academic support can make
Minoxidil for hair loss
A woman with androgenetic alopecia asks about medication options. You prescribe:
Group of answer choices
Anthralin
Cyclosporine
Finasteride
Minoxidil
Key Points
Nurses analyze cues to determine blood pressure hypotheses.
Criteria to prioritize blood pressure hypotheses include life-threatening, ABCs, acute versus chronic, and, if resolved, would affect other hypotheses.
The overall goal is to return the blood pressure to expected ranges.
Solutions focus on increasing or decreasing blood pressure depending upon the situation.
Question 1 of 4
Which action would the nurse take to obtain patient observation cues to determine blood pressure alterations?
Exactly!
Question the patient.
Review the patient’s blood pressure on the graphic.
Check the patient’s medication record.
Read the patient’s history in the chart.
Question the patient.
Questioning the patient allows the nurse to obtain patient observation cues for blood pressure alterations.
Review the patient’s blood pressure on the graphic.
Reviewing the patient’s blood pressure on the graphic allows the nurse to obtain a medical record cue, not a patient observation cue.
Check the patient’s medication record.
Checking the medication records allows the nurse to obtain a medical record cue, not a patient observation cue.
Read the patient’s history in the chart.
Reading the patient’s history in the chart allows the nurse to obtain a medical record cue, not a patient observation cue.
Question 2 of 4
Match the hypothesis to its pathophysiologic cause.
Exactly!
Hypovolemia and decreased cardiac output
Hypotension
Peripheral vasodilation with no compensation
Postural hypotension
Thickened arteries that reduce compliance
Hypertension
Question 3 of 4
Which patient situation would the nurse assess first?
Exactly!
Absence of breathing
Hypotension
Hypertension
Orthostatic hypotension
Absence of breathing
Absence of breathing is the patient situation to assess first because of the ABCs; breathing is compromised.
Hypotension
Although hypotension is critical, it does not take precedence over breathing because hypotension is a circulation problem.
Hypertension
Although hypertension can be critical, it does not take precedence over breathing because hypertension is a circulation problem.
Orthostatic hypotension
Although orthostatic hypotension is unexpected, it does not take precedence over breathing because orthostatic hypotension is a circulation problem.
Question 4 of 4
Which outcome would the nurse develop for a patient with hypotension?
Exactly!
Patient’s low blood pressure resolves.
Patient’s vital signs will be within expected ranges.
Patient’s blood pressure will return to expected ranges 2 hours after treatment.
Patient will return to previous levels of functioning.
Patient’s low blood pressure resolves.
This is a goal, not an outcome, for hypotension. “Resolves” is not measurable and there is no timeline, making this an inappropriate outcome.
Patient’s vital signs will be within expected ranges.
This is a goal, not an outcome, for hypotension. There is no timeline, making this an inappropriate outcome.
Patient’s blood pressure will return to expected ranges 2 hours after treatment.
This is an outcome because it uses the SMART method: is specific, measurable, achievable, realistic, and timebound.
Patient will return to previous levels of functioning.
This is a goal, not an outcome, for hypotension. There is no timeline, making this an inappropriate outcome.
Alterations: Hypotension and Orthostatic Hypotension
Hypotension is low blood pressure. An individual who is highly trained physically (athlete, military) may be expected to have low blood pressure. To help the nurse recognize cues, information about the two types of hypotension is discussed.
Hypotension
Orthostatic (Postural) Hypotension
Definition
A decrease in blood pressure (as shown in the image, BP 76/37 with pulse 46 and O
2
sat 98%)
A decrease in blood pressure upon a change in position, such as from lying to sitting to standing
Causes and Contributing Factors (not all-inclusive)
Reduced cardiac output (e.g., heart attack or heart failure)
Decreased peripheral vascular resistance (e.g., shock)
Reduced blood volume (e.g., hemorrhage or blood loss from injury)
Extreme vasodilation (e.g., severe allergic reaction)
Certain medication side effects, especially blood pressure medication
Vasodilation causes blood to pool in lower extremities rather than being returned to the heart
Aging
Certain medication side effects, especially blood pressure medication
Prolonged immobility
Dehydration
Anemia (low red blood cells)
Recognize Cues/Signs and Symptoms
Patient Observation Cues
Cool, clammy skin
Confusion
Patient Observation Cues
Dizziness
Feels faint upon position change
Medical Record Cues
Vital signs flow sheet/graphic indicates systolic blood pressure less than 90 or diastolic less than 60
Vital signs flow sheet/graphic indicates 20 to 30 mm Hg below the patient’s expected systolic blood pressure
Vital signs flow sheet/graphic indicates tachycardia and will eventually become thready
Intake and output flow sheet indicates decreased urine output
Medical Record Cues
Vital signs flow sheet/graphic indicates sudden drop of at least 20 mm Hg in systolic pressure or 10 mm Hg in diastolic pressure upon position change
Immediate Concern
Is an immediate concern and can become a
medical emergency
Is an urgent concern unless the patient begins to fall, then becomes immediate
Putting It into Practice
The patient is a 73-year-old male recovering from hip replacement surgery. The patient has been experiencing dizzy spells when sitting up. The nurse assesses the patient’s blood pressure lying down, and it registers 124/85 mm Hg. Then, after sitting up for 1 minute, the blood pressure is 100/70 mm Hg. Ensuring that the patient is secure, the nurse then assesses the BP a third time while standing. This BP is 98/66 mm Hg. During the interview the nurse discovers that the patient has not been eating or drinking regularly since the surgery and that he was immobile for 5 weeks before surgery. Finally, as the nurse reviews the chart, the nurse notices that the patient is taking several new medications.
Using Clinical Judgment: Recognize Cues
Which cues are of immediate concern and require you to take action?
Drop in blood pressure of at least 20 mm Hg systolic and 10 mm Hg diastolic from previous blood pressure after changing position (124/85 to 100/70 to 98/66).
Dizziness when getting up after lying down.
What is your first impression?
The patient is experiencing orthostatic (postural) hypotension.
Question 1 of 5
Which area is the
most
common site for a blood pressure measurement?
Exactly!
Wrist
Lower leg
Upper leg
Upper arm
Wrist
The radial artery at the wrist is used to palpate a blood pressure measurement, but it is not the most common site.
Lower leg
Palpating the dorsalis pedis or posterior tibial artery of the lower leg is sometimes used to palpate blood pressure; however, the lower leg is not the most common site.
Upper leg
Although the popliteal artery can be used if the brachial is not accessible, it is not the most common site.
Upper arm
The upper arm at the brachial artery is the most common site to measure blood pressure.
Question 2 of 5
Which questions would the nurse ask the patient before measuring blood pressure?
Exactly!
Are you in pain?
Do you feel stressed?
Have you exercised within the past 5 minutes?
Have you consumed any caffeine in the last 30 minutes?
Have you been to physical therapy within the past 15 minutes?
Do you continuously monitor your blood glucose levels with a device on your arm?
Are you in pain?
The nurse would ask this question because acute pain can increase blood pressure.
Do you feel stressed?
The nurse would ask this question because stress can increase blood pressure.
Have you exercised within the past 5 minutes?
The nurse would not ask this question because exercise affects blood pressure for about 15 minutes, not 5.
Have you consumed any caffeine in the last 30 minutes?
The nurse would ask this question because caffeine can affect blood pressure.
Have you been to physical therapy within the past 15 minutes?
Physical therapy is exercise; thus, the nurse would ask this question because activity can affect blood pressure for about 15 minutes.
Do you continuously monitor your blood glucose levels with a device on your arm?
The nurse would ask this question because blood pressure must be taken in the other arm if this device is present.
Question 3 of 5
Which blood pressure measurement is an unexpected finding?
Exactly!
Newborn: 70/40
6-year-old: 90/60
15-year-old: 110/68
Adult: 128/84
Newborn: 70/40
This is an expected finding rather than an unexpected finding because the expected blood pressure for a newborn is 60–90 over 20–60.
6-year-old: 90/60
This is an expected finding rather than an unexpected finding because the expected blood pressure for a 6-year-old is 84–<120 over 54–<80. 15-year-old: 110/68 This is an expected finding rather than an unexpected finding because the expected blood pressure for a 15-year-old is 94–<120 over 62–<80. Adult: 128/84 This is an unexpected finding because the expected blood pressure for an adult is 90–<120 over 60–<80; this patient’s blood pressure is 128/84. Question 4 of 5 Match the blood pressure measurement to its classification. Exactly! Hypertension stage 1 130–139 systolic Elevated <80 diastolic with systolic 120–129 Hypertension stage 2 ≥90 diastolic Question 5 of 5 Which cue would alert the nurse that a patient may be experiencing orthostatic hypotension? Exactly! Patient feels faint upon position change. Blood pressure increases when patient stands. Patient experiences paralysis in legs. Blood pressure remains constant during transfers. Patient feels faint upon position change. A patient with orthostatic hypotension will feel faint upon position change because of the sudden drop in blood pressure. Blood pressure increases when patient stands. In orthostatic hypotension, blood pressure decreases when the patient stands rather than increases. Patient experiences paralysis in legs. Paralysis in the legs is not a cue for orthostatic hypotension. Dizziness upon position changes is a cue for orthostatic hypotension. Blood pressure remains constant during transfers. There are sudden drops in blood pressure during transfers if the patient is experiencing orthostatic hypotension.
Clinical I NSG522 Blood Pressure
Physiology of Blood Pressure
The physiology of blood pressure (BP) is as follows:
What Is BP?
Blood pressure refers to the force of blood exerted against arterial walls.
The heart contracts, causing the left ventricle to push blood through the aorta and circulatory system.
As the heart contracts, pressure rises; as the heart relaxes, pressure falls.
This rise and fall creates a pressure wave throughout the arterial system.
What Are the Parameters of BP?
Blood pressure is written as a fraction and is measured in millimeters of mercury (mm Hg).
Consider a BP of 120/80 mm Hg:
The 120 is the systolic pressure, or the maximum pressure the heart exerts during contraction.
The 80 is the diastolic pressure, or the lowest amount of pressure in the arteries when the heart relaxes.
Pulse pressure (force that the heart generates with each contraction) is the numeric difference between the diastolic and systolic pressures, which in this case is 40 (120 – 80 = 40).
What Are Stroke Volume and Compliance?
Stroke volume and the compliance of the arterial system help determine blood pressure.
Stroke volume is the amount of blood injected into the arteries with each heartbeat.
An increase in stroke volume increases blood pressure.
A decrease in stroke volume decreases blood pressure.
However, if the increase or decrease in stroke volume is sustained, detrimental effects can occur, such as hypertension and shock.
Compliance refers to the elasticity of the arterial system, especially the arteries.
Flexible arteries have a high compliance.
Stiff arteries have a low compliance.
Regulation of Blood Pressure
The left ventricle is not the only mechanism for regulating blood pressure. The renin-angiotensin-aldosterone system causes vasoconstriction and sodium/water retention to increase blood pressure when needed.
Other mechanisms function in tandem to contribute to both BP regulation and maintenance of tissue perfusion.
Blood Pressure Regulation
Blood Vessels
Arteries
Contain elastic tissue for stretching, distension, and compliance
Stretch with systolic pressure, relax with diastolic pressure
Maintain enough pressure for continuous flow into capillaries
Arterioles
Control delivery of blood to organs, tissues, and cells
Remain partially contracted to provide peripheral resistance (a major factor in blood pressure)
Mechanisms
Autonomic Nervous System (ANS)
Manages mechanisms used for short-term regulation of blood pressure
Responds to circulatory system signals
Responds to triggers like pain and cold
Antidiuretic Hormone (ADH)
Releases in response to low blood pressure
Causes water to be retained, which increases blood pressure
Previous
Factors Influencing Blood Pressure
Internal and external factors can increase or decrease blood pressure:
Factors
Effects on Blood Pressure
Aging
Increases from decreased compliance (elasticity) of arteries, causing an increase in peripheral resistance
Gender
Generally decreased in women until menopause
Race
Generally increased to hypertension levels in Blacks
Medications
Increases in some women taking oral contraceptives; bronchodilators can not only increase pulse but also blood pressure; there are many others that can increase or decrease blood pressure
Weight gain
Increases as weight increases
Circadian rhythm
Decreased in morning and slightly increases in late afternoon
Head injury
Increases from increased intracranial pressure
Increased blood volume
Increases from the extra fluid
Food intake
Increases after eating; sodium intake may increase blood pressure
Emotions
Increases with anger, fear, and excitement
Pain
Increases with pain
Shock
Decreases and can become life-threatening if continues to decrease
Vasodilation
Decreases because the increase in diameter of blood vessels (enlarges) causes less resistance
Vasoconstriction
Increases because the decrease in diameter of blood vessels (narrows) causes more resistance
Question 1 of 3
Which information is accurate about blood pressure?
Exactly!
Blood pressure is measured by subtracting the diastolic from the systolic pressure.
The numerator is the diastolic pressure.
Blood pressure is the force against the venous walls.
The heart exerts maximum pressure during contractions.
Blood pressure is measured by subtracting the diastolic from the systolic pressure.
Pulse pressure, not blood pressure, is the numeric difference between the diastolic and systolic pressure.
The numerator is the diastolic pressure.
The numerator is the systolic pressure; the denominator is the diastolic pressure.
Blood pressure is the force against the venous walls.
Blood pressure is the force against the arterial walls, not the venous walls.
The heart exerts maximum pressure during contractions.
The heart exerts maximum pressure, the systolic pressure, during contractions.
Question 2 of 3
Match the blood vessel or mechanism of blood pressure regulation to its function.
Exactly!
Controls delivery of blood to organs, tissues, and cells
Arterioles
Manages mechanisms used for short-term blood pressure regulation
Autonomic nervous system
Allows a continuous flow of blood into capillaries
Arteries
Releases in response to low blood pressure to retain water
Antidiuretic hormone
Previous
Question 3 of 3
Which factors increase blood pressure?
Exactly!
Shock
Head injury
Weight gain
Vasodilation
Acute pain
Shock
Shock decreases (not increases) blood pressure and can be life-threatening if it becomes severely reduced.
Head injury
Head injury increases blood pressure from increased intracranial pressure.
Weight gain
Weight gain increases blood pressure.
Vasodilation
Vasodilation decreases (not increases) blood pressure because the increase in diameter of blood vessels (enlarges) causes less resistance.
Acute pain
Acute pain increases blood pressure.
Brachial Site
Brachial artery.
The most common site for a blood pressure assessment is the brachial artery in the upper arm.
Cautions
If the patient has had any axillary node procedures or a mastectomy (breast removal), blood pressure should not be taken on the side the procedure was performed to prevent lymphedema (swelling).
A brachial artery reading is avoided in the following situations:
Presence of an arteriovenous fistula or shunt
Diseased arm, shoulder, or hand
Presence of a cast or bulky dressing
Infusion of intravenous fluids
Other Sites
A general overview of other sites that may be used to obtain a blood pressure measurement is presented, but the module focuses on the brachial blood pressure because it is most commonly used for vital sign measurements.
Popliteal
If the brachial artery is not accessible, the popliteal artery can be used.
Considerations:
Systolic blood pressure in the leg is approximately 20 mm Hg higher when compared to the brachial artery.
Diastolic pressure is usually the same in the leg and the brachial artery.
The blood pressure is recorded as 138/78 popliteal because any site other than the brachial must be documented.
Radial, Posterior Tibial, and Pedal
In some instances, the radial artery at the wrist or the posterior tibial and dorsalis pedis (pedal) arteries of the lower leg can be used.
Considerations:
These sites are used when the blood pressure cannot be obtained in the brachial or popliteal site or when blood pressure is low and cannot be heard with a stethoscope.
The blood pressure is palpated with the nurse’s fingers, and only a systolic reading is obtained.
The blood pressure is recorded as 60 palpable.
Equipment for Measuring Blood Pressure
Common equipment and devices used for measuring blood pressure are described below.
BP Cuff with Sphygmomanometer (Gauge)
Measures BP either manually or automatically; has a bladder that inflates and deflates.
Measures the systolic and diastolic pressures (gauge).
If used for constant monitoring (electronic, automatic), it is important to set alarms that trigger if a reading is too high or too low (do not turn off alarms; check cuff position frequently and remove to monitor skin integrity).
Cuff Sizes
Comes in a variety of sizes to fit accurately.
Cuff bladder should be 60% to 80% of the circumference of the extremity being used.
Cuff width should be 40% of the circumference of the extremity.
Stethoscope
Allows user to hear sounds coming from inside the body.
Allows user to hear Korotkoff sounds (the changing sound of blood flow made as the blood pressure cuff deflates).
Electronic
Measures blood pressure at the wrist or brachial artery.
Easy for patients to use in the home setting.
Electronic, or automatic, blood pressure measurement devices are invaluable for use with the critically ill or potentially unstable patient.
Errors in Blood Pressure Measurements
Possible errors can occur when assessing a patient’s blood pressure, including the following.
Measurement Errors
Faulty equipment
Equipment that has not been calibrated correctly
Improper use of equipment
Incorrect patient positioning
Gauge too far away to read
Clinical I NSG522 Blood Pressure
Falsely Low Measurements
Hearing deficit in the person performing the assessment
Patient’s arm above heart level
Noisy environment
Use of a cuff that is too wide for the patient’s arm
Stethoscope positioned improperly in nurse’s ears
Broken or kinked cuff tubing
Cuff deflated too rapidly
Falsely High Measurements
Assessment too soon after the patient smokes or exercises
Use of a cuff that is too narrow
Cuff deflated too slowly
Cuff bladder reinflated before completely deflated
Questions to Ask Before the Assessment
Blood pressure is measured after the patient has not smoked or ingested caffeine for at least 30 minutes. Obtaining an accurate baseline is critical.
Before a blood pressure assessment, the nurse would ask the patient the following questions because these factors can affect the blood pressure reading or may indicate an underlying heart condition:
Have you exercised or been to physical therapy within the past 15 minutes?
Is there a family history of hypertension?
Do you have any medical devices, like diabetic continuous glucose monitors, on your arm (BP should be taken in the other arm)?
How would you rate your pain level on a scale from 0 to 10?
How would you describe your stress level?
Measuring Brachial Blood Pressure
The technique for taking a blood pressure depends on the site and whether the equipment is manual or electronic.
Manual One Step Method
To obtain a blood pressure manually, use a cuff with a sphygmomanometer and stethoscope.
Position patient sitting or supine, supported arm at heart level, and legs uncrossed.
Locate where to place the stethoscope by palpating for the brachial pulse.
Place cuff 1 inch (2.5 cm) snugly above the antecubital fossa with arrow pointing to the brachial artery pulse.
Position gauge for easy reading.
Place stethoscope over brachial artery and place into ears.
Inflate cuff 30 mm Hg above the patient’s usual systolic reading.
Deflate cuff at a rate of 2 mm Hg/second.
Remember the first Korotkoff sound (first sound heard) will be the systolic reading.
Remember the last Korotkoff sound (last sound before silence) will be the diastolic reading.
There may be an auscultatory gap (absence of sound after the first Korotkoff sound that is as wide as 40 mm Hg; continue to listen). If a gap is noticed, document the finding (e.g., auscultatory gap of 20 mm Hg).
Record as 112/68.
Electronic
Position patient sitting or supine, supported arm at heart level, and legs uncrossed.
Place cuff 1 inch (2.5 cm) snugly above the antecubital fossa with arrow pointing to the brachial artery pulse (palpate to find pulse).
Turn machine on.
Push start button.
Note and record reading (according to image, BP 134/71 with a pulse rate of 83).
Because low blood pressure is not easily picked up by an electronic device, it is not appropriate to use in patients:
With an irregular heart rate
Who are shivering
Experiencing seizure activity
With systolic blood pressure less than 90 mm Hg
Expected and Unexpected Findings
Expected Findings
Expected findings depend on the patient’s age.
Newborn
1-year-old
6-year-old
15-year-old
Adult and Older Adult
Systolic
60–90
74–100
84–<120 94–<120 90–<120 Diastolic 20–60 50–70 54–<80 62–<80 60–<80 From Yoost, B. L., & Crawford, L. R. (2020). Fundamentals of nursing (2nd ed.) Elsevier. Unexpected Findings Values above systolic or diastolic Values below systolic or diastolic A 20 to 30 mm Hg change (either upward or downward) in either the systolic or diastolic reading when compared to an earlier reading Factors Involved in Cue Recognition To accurately recognize cues for blood pressure, the table provides information for relevancy and irrelevancy. The nurse must also recognize which blood pressure cues are the most important and/or an immediate concern. Relevant Relevant cues relate to important information about blood pressure that the nurse obtains from patient questions, vital sign assessment, patient observation and medical record cues, and signs and symptoms. These help the nurse decide what is relevant. Example: Has increased BP, 150/90 Reports a headache Has a family history of heart disease and strokes Irrelevant cues relate to information that is not a factor or contributing factor to the patient’s blood pressure. Example: Is married Has six grandchildren Had prostate surgery 10 years ago The most important cues relate to severely elevated or decreased blood pressure readings. Example: Has BP of 220/110 mm Hg Generally, low blood pressure values are of immediate concern. Example: Has blood pressure of 60/40 ( medical emergency, indicates shock or possible myocardial infarction [heart attack]) Classifications of Hypertension Hypertension is elevated blood pressure. Sustained levels of hypertension can damage the heart, brain, kidneys, and other body systems. Prolonged hypertension can lead to cardiovascular disease, increased risk for stroke, atherosclerosis (the yellow buildup in the image), and thickened arterial walls. There are different classifications for hypertension depending upon the measurement. Clinical I NSG522 Blood Pressure One reading does not establish hypertension. Readings on two or more occasions on different days at different times over a period of time are assessed before diagnosing high blood pressure. The classifications for adults with no prior history of hypertension are as follows: Classification Systolic (mm Hg) Modifier Diastolic (mm Hg) Elevated 120–129 And <80 Hypertension stage 1 130–139 Or 80–89 Hypertension stage 2 ≥140 Or ≥90 Alteration: Hypertension Cues to recognize hypertension are presented below. Causes Neurohormonal dysfunction from overstimulation of angiotensin and aldosterone, causing blood pressure to increase Primary: No known cause Secondary: Caused by a specific disease (kidney or heart disease) Contributing Factors Family history of hypertension Inactive lifestyle Obesity Prolonged stress Smoking Alcohol use Diet high in: Salt Fat Calories Recognizing Cues/Signs and Symptoms Patient Observation Cues Usually asymptomatic (primary reason BP screenings are necessary) Headache Blurred vision Nose bleeds Dizziness Facial redness Medical Record Cues Vital signs graphic/flow sheet indicates elevated blood pressure readings Nurse’s notes indicate unexpected (abnormal) heart sounds History indicates a family history of hypertension Immediate Concern Is urgent but not immediate unless BP is severely elevated or combined with signs and symptom of stroke (facial drooping, difficulty speaking and/or moving arms) Alterations: Hypotension and Orthostatic Hypotension Analyzing Blood Pressure Cues Interventions and Evaluation: Hypertension Clinical I NSG522 Blood Pressure
NSG 522 Advanced Pharmacology University of Phoenix Week 1
NSG/522 Week 1 Knowledge Check
Question 1; Drugs that have a significant first-pass effect:
A. Must be given by the enteral (oral) route only
B. Bypass the hepatic circulation
C. Are rapidly metabolized by the liver and may have little, if any, desired action
D. Are converted by the liver to more active and fat-soluble forms
Question 2; A primary care NP wishes to order a drug that will be effective immediately after administration of the drug. Which route should the NP choose?
A. Rectal
B. Topical
C. – Sublingual
D. Intramuscular
GET EXAM, CLASS OR ASSIGNMENT HELP HERE
Question 3; A primary care NP is preparing to prescribe a drug and notes that the drug has nonlinear kinetics. The NP should:
A. Monitor frequently for desired and adverse effects
B. Administer a much higher initial dose as a loading dose
C. Monitor creatinine clearance at baseline and periodically
D. Administer the drug via a route that avoids the first-pass effect
Question 4; Pharmacokinetic factors that affect prescribing include:
A. Therapeutic index
B. Minimum effective concentration
C. Bioavailability
D. Ease of titration
NSG/522
Advanced Pharmacology
Course level:
NUR Graduate
Please Note: Attendance and participation are mandatory in all University courses, and specific requirements may differ by course. If attendance requirements are not met, a student may be removed from the course. Please review the Course Attendance Policy in the Catalog for more information.
University of Phoenix reserves the right to modify courses. While widely available, not all programs are available to residents of all states. Please check with a University Enrollment Representative.
This advanced course fosters an in-depth understanding of pharmacological principles based on evidenced-based guidelines, cultural, socioeconomic, and legal influences and strengthens the ability to use and apply this information across the lifespan. The physiological, biochemical, and anatomical considerations for safe medication administration, including the interaction of drugs and chemicals with body systems, will be presented. Over the counter and complementary and alternative medications will be discussed for certain disease states.
NSG/522 Advanced Pharmacology is designed for students enrolled in master’s degree tracks that do not lead to nurse practitioner licensure or certification. This course does not meet the educational requirements for advanced practice registered nurse (APRN) licensure and is not intended to prepare students for nurse practitioner certification exams. NSG 522 Advanced Pharmacology University of Phoenix Week 1
This course is not available for enrollment to residents of Alabama, Idaho, Minnesota, Mississippi, New York, Tennessee, Washington,
Washington, D.C.,
and Wyoming.
Prerequisites
Completion of a Bachelor of Science in Nursing (BSN) degree
A valid, unrestricted/unencumbered RN license
Required materials
The materials required for this NSG 522 Advanced Pharmacology University of Phoenix Week 1 course are covered in your resource fees.
Chapter 2, Quality and Safety – Quality Improvement Process and Customer Satisfaction in Healthcare
Question 1 of 6
Report content error
Which factor differentiates the unique focus of risk management from other quality activities?
Prevents severe harm
Risk management focuses on protecting the organization from malpractice and other financial claims but does not directly prevent harm.
Incorrect
Correct
Prevents damage to the organization
Risk management identifies and attempts to mitigate situations that put the organization’s finances or public image at risk.
Removes unsafe clinicians
Risk management is focused mainly on the organization’s well-being. Removing unsafe clinicians is a function that is shared in risk and quality activities.
Fulfills requirements of The Joint Commission (TJC)
Risk and quality management programs both work to achieve TJC National Patient Safety Goals, but that is a similarity and not a difference.
Question 2 of 6
Report content error
Which manager’s recommendation would likely face resistance from the nursing staff?
Better staffing ratios are associated with decreased mortality.
Advocacy for better nurse-to-patient ratios will likely be met with support from nurses who are accustomed to the nursing shortage.
Correct
Twelve-hour shifts will increase errors due to fatigue.
Twelve-hour shifts and the associated 3-day workweek are popular among nurses, and proposals to eliminate the 12-hour option for safety will be met with some resistance.
Nurses must function at top of license and avoid work that can be delegated.
Advocating for nurses to do the work they were trained to do is a popular recommendation that nurses will support.
Nurses must use their vacation time to avoid burnout.
Vacation time is difficult to grant when staffing is low, but the decision to encourage the use of vacation time will be embraced by nurses.
Question 6 of 6
Report content error
To effectively promote diversity, which intervention would the manager take?
Mandating staff’s respect for cultural differences
Culture is deeply ingrained, so simply telling staff to respect other cultures is not likely to be effective.
Correct
Inviting a culturally different patient to speak at a staff meeting
Having a patient speak about their experience is effective because it helps nurses become aware of the feelings and difficulties the patient experienced during their care.
Providing staff lists of common cultural differences
Lists of differences may not be effective in promoting diversity because it is difficult to apply one list to any given culture.
Including cultures of admitted patients during the morning report
Culture may not be obvious, so nurses must be aware and integrate culture into their assessment. Simply reporting a patient’s culture is not likely to give enough information.
Question 3 of 6
Report content error
Which strategy is used by nurses to prevent events leading to permanent disability of a patient?
Instituting a zero-tolerance policy for errors
Zero-tolerance policies deal with behaviors that are not allowed. They cannot be applied to errors which are not avoidable.
Correct
Designing processes that anticipate adverse events and protect patients
Implementing measures to anticipate complications and reduce harm, such as requiring reversal agents at the bedside during sedation, is the best strategy for nurses to prevent disability.
Performing root cause analysis after events that result in severe patient harm
Root cause analysis occurs after harm has occurred, so it is not a good strategy for prevention.
Avoiding performing interventions that pose risk to the patient
Most nursing and medical interventions pose some risk to patients and cannot be avoided.
Question 4 of 6
Report content error
Which nurse’s action enhances quality improvement efforts?
Educating staff on handoff procedures for helicopter transport occurring two to three times per year
This is a high-risk procedure but occurs rarely, so there is little impact if the nurse focuses on it as an improvement opportunity.
Correct
Reinforcing education for emergency transport to ICU that occurs once or twice times per week
Transfers to the ICU are relatively frequent and potentially high-risk and thus would have a strong impact on nurses and patient safety. This is the most appropriate area on which to focus improvement efforts.
Providing education for post-mortem care that is performed once or twice times per month
Post-mortem care is a low-risk procedure and will not be an impactful area to focus improvement efforts.
Inservice organ donation procedure that occurs one to three times per year
Organ donation is important to do correctly but is an extremely low-volume procedure, which would not be best for improvement efforts since education will be forgotten between events.
Question 5 of 6
Report content error
To compensate for healthcare disparities, which group would need the
most
support?
Russian immigrants who speak limited English
Limited English proficiency is easily overcome with today’s technology, allowing almost any language to have a qualified translator on demand.
Correct
Non-English–speaking Guatemalan refugees with a 4th-grade education level
A combination of not speaking English and having a low education level, along with refugee status, means that this group would most need support since they may not know how to access healthcare and need resources to understand their condition and treatment.
Iranian immigrants reluctant to seek care due to discrimination
Reluctance to seek care may improve over time with positive interactions, so this group is not in the greatest need of support.
Haitian immigrants seeking care only after home remedies have failed
Using home remedies may cause this group to present with more advanced conditions, but the support they require is less than other groups with multiple barriers.