Question

What order should you follow from the steps below to assess a patient for jugular venous distension? (Go by the numbers for each step)


1. Place a centimeter ruler on the sternal angle of the client’s chest.
2. Place the client on a bed with the head of the bed raised to a 45- to 60-degree angle.
3. Measure the distance from the sternal angle to the horizontal level of the distended neck veins.
4. Check that the sternal angle is approximately 5 cm above the right atrium.

Group of answer choices

4, 2, 3, 1

3, 2, 4, 1

1, 3, 2, 4

2, 1, 4, 3

Answer 1

To assess a patient for jugular venous distension, the order of the steps should be:

2. Place the client on a bed with the head of the bed raised to a 45- to 60-degree angle.
1. Place a centimeter ruler on the sternal angle of the client’s chest.
4. Check that the sternal angle is approximately 5 cm above the right atrium.
3. Measure the distance from the sternal angle to the horizontal level of the distended neck veins.

So the correct order is **2, 1, 4, 3**.