HESI LPN Exit Exam IV Proctored Exam
The unlicensed assistive personnel (UAP) reports to the practical nurse (PN) that an older adult client has a radial pulse of 55 beats/minute. Which intervention should the PN implement first?
Explanation & Rationale
A. Notifying the charge nurse is important but should come after confirming the accurate heart rate assessment. B. Holding a prescribed morning dose of digoxin may be necessary if bradycardia is confirmed, but the first step is to accurately assess the heart rate. C. Obtaining a full minute apical pulse assessment is the first step to verify the radial pulse rate reported by the UAP and ensure an accurate and comprehensive assessment of the client's heart rate. D. Reviewing the client's baseline vital signs is useful but should follow a thorough and accurate assessment of the current heart rate.
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