While observing an assistive personnel (AP) obtaining vital signs from an adult client, which action requires follow-up?

• A. The AP pulls the pinna up and back when obtaining a tympanic temperature.
• B. The AP informs the client when they are counting the respirations.
• C. The AP gently presses down with the pads of two to three fingers over the radial pulse site.
• D. The AP selects a blood pressure cuff width that is 40% the circumference of the client's arm.

Answer: (B)

Respiratory rate must be counted without the client knowing you’re counting. If you tell the patient you’re counting their respirations, they may alter their breathing, which makes the measurement inaccurate. The right approach is to observe and count quietly for a full minute (watching chest rise and fall, or count for 30 seconds and multiply by two only if you’re confident the rate is regular). The other actions shown reflect proper technique: using the correct adult method to position the tympanic thermometer, palpating the pulse with two to three fingers, and selecting a cuff width about 40% of the arm’s circumference. But informing the patient that you’re counting respirations can change the result, so that action should be followed up.