CRNE Exam Prep

Category - Changes in Health

A client is admitted to the facility due to right-sided heart failure. The nurse notes that the client demonstrates distention of the jugular vein. The nurse places the head of the bed in which of the following positions to obtain the most accurate jugular venous pressure reading?
  1. Raised to 45degrees
  2. Raised to 90degrees
  3. Raised between 15 and 30degrees
  4. Raised between 45 and 90degrees
Explanation
Answer: C - The head of bed is raised between 15 and 30degrees to obtain the most accurate jugular venous pressure reading. When the head of bed is raised higher than 30degrees, the veins are less discernable above the clavicle. When the head of bed is lower than 15degrees, increased pressure is not detectable.
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