Describe the steps to correctly take a manual blood pressure using a stethoscope and sphygmomanometer.

• A. Apply cuff to upper arm at heart level, palpate brachial pulse, inflate cuff 30-40 mmHg above palpated systolic, listen for the first korotkoff sound and the diastolic point, slowly release, record value and ensure comfort
• B. Palpate brachial artery, place stethoscope over radial artery, inflate 20 mmHg above pulse, listen for systolic
• C. Inflate cuff to 200 mmHg, listen for korotkoff sounds, then slowly release
• D. Apply cuff to forearm, palpate radial pulse, place stethoscope over brachial artery, inflate 30-40 above palpated systolic, listen for the first korotkoff sound

Answer: (D)

Take a manual blood pressure reading by occluding the brachial artery and listening for the return of blood flow. Have the person seated with back supported, feet uncrossed, and the arm supported at heart level. Place a properly sized cuff on the upper arm, with the cuff bladder centered over the brachial artery and the lower edge about an inch above the elbow. Palpate the brachial pulse to guide placement and to estimate where to position the cuff so the artery lies under the center of the cuff. Put the stethoscope over the brachial artery (not under clothing) and ensure a quiet environment. Inflate the cuff to about 20-30 mmHg above the palpated systolic pressure (some protocols use 30-40 mmHg above) to reliably occlude the artery. Begin to slowly deflate, about 2-3 mmHg per second, while listening for Korotkoff sounds. The systolic value is read at the first tapping sound, and the diastolic value is read when the sounds disappear (or at the fifth Korotkoff sound, depending on the method used). Record the reading accurately and ensure the patient is comfortable. Use the correct technique throughout, including supporting the arm at heart level and avoiding a forearm cuff or placing the stethoscope over the radial artery, as those steps lead to inaccurate results.