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Measuring Vital Signs

Subjects : health-sciences, emergency-medicine

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Symptoms of hypoxia
the lungs
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
+1
16-20

2. Enviromental temperature BP?
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
apnea
Kussmaul's respiration
Sinoatrial node (SA NODE)

3. Fast - deep respirations with abrupt pauses

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4. Feel
thready
Vascular resistance drops and the blood pressure decreases
palpate
Posterior tibial

5. Korotkoff sounds Ausculatatory gap:
96.5 to 97.5
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
Evaporation
bradycardia

6. Excessive sweat production
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
120/80
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
Diaphoresis

7. Signs and symptoms of shock
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
when it is difficult to find or to count the radial pulse - or for patients with heart conditions for one full minute by placing stethoscope on the heart to count for a full minute.
72 bpm
by placing the flat part of the first fingers against the tendon - or cord - on the thumb inside of the inner wrist and ten rolling the fingers slightly outward into the little trough on the thumb inside the wrist.

8. Blood pressure for any adult should be no higher than
dehydration - delirium - and convulsons may occur. Dehydration will occur because of lost with perspiration and more rapid breathing. Delirium and convulsions may occur because neurologic function is affected when the temperature in the brain rises.
Cardiac Output
120/80
Hyperventilation

9. Groin area
Febrile stage - the body temperature rises to a new set point established by the hypothalamus and remains there until there is a resolution to the cause of fever.
Stertor
from drug therapy - a neurologic problem or dehydration.
Femoral

10. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
Hyperthermia related to infection or excessive heat exposure
Rhonchi
lysis
Radial

11. Disappearance of sound. (marks diastolic pressure in adults)
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
in the alveoli - tiny thin-walled sacs
Korotkoff sounds Phase V: Silence
Eupnea

12. How does age affect pulse?
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
bradycardia
The pulse rate gradually diminishes from birth to adulthood
Relapsing

13. Elevated temperature
fever
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
crackles
Posterior tibial

14. How do emotions increase the pulse rate?
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
thready
Acute anxiety stimulate the nervous system - raising the pulse.
Respiration

15. The temperature of the deep tissues of the body
Core Temperature
Diastolic pressure
Feeble
men - African Americans - under a lot of stress - obese

16. State of insufficient oxygen
ausculatation
lysis
Axillary.
hypoxia

17. A pattern of breathing in which there is an increase in the rate and the depth of breaths and carbon dioxide is expelled - causing te blood level of carbon dioxide to fall. this condition is seen after sever exertion - during high levels of anxiety o
blood pressure is lowest in the morning. and higher in the afternoone
uncooperative patient - children - combative patients - dementia
Hyperventilation
97.5 to 99.5

18. Obtaining the correct size for a cuff for BP?
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
the palpation method is used. put cuff over arm - feel the radial point to get the systolic pressure you cant get the diastolic this way.
when it is difficult to find or to count the radial pulse - or for patients with heart conditions for one full minute by placing stethoscope on the heart to count for a full minute.
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes

19. What pulse is checked to determine whether there is any blockage of circulation in the artery up to that point - especially in patients who have had cardiac catherization using the femoral artery for the insertion of the catheter or those who had sur
140-159/90-99
Pedal pulse
16-20
wheeze

20. The volume of blood pushed into the aorta per heartbeat.
The body's temperature in the morning is usually low from inactivity of the muscles. The afternooon body temperature may be high-normal because of the body's metabolic processes - the patient's activity - and the temperature of the environment.
Hyperventilation
from drug therapy - a neurologic problem or dehydration.
Stroke volume

21. High oxygen
Systolic pressure
hyperoxia
Tachypnea
Hyperventilation

22. Rectal temperature are
about 1 degree higher than oral temperatures
hypoxia
30-80
Stertor

23. How does size affect pulse?
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Respiration
left Sims position

24. Healthly adult
hyperoxia
12-20
Nursing interventions to reduce fever
16-20

25. How does emotional stress raise the body's temperature?
wheeze
The emotions increase hormone secretion - and the body activities required for this increase heat production.
16-20
Cardiac Output

26. Carbon dioxide is carried as bicarbonate ion in the blood until it reaches where?
the lungs
Axillary.
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
uncooperative patient - children - combative patients - dementia

27. BP at or lower 90/60.
intermittent
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
males have higher bp - until menopause then they are the same
hypotension

28. Sex BP?
males have higher bp - until menopause then they are the same
It will also fall
the rate - the rhythm - and volume
^160/^100

29. When is apicial pulse used?
men - African Americans - under a lot of stress - obese
when it is difficult to find or to count the radial pulse - or for patients with heart conditions for one full minute by placing stethoscope on the heart to count for a full minute.
apnea
It will also fall

30. Head injury BP?
raises BP.
The pulse rate gradually diminishes from birth to adulthood
Pedal pulse
when it is difficult to find or to count the radial pulse - or for patients with heart conditions for one full minute by placing stethoscope on the heart to count for a full minute.

31. How does disease increase the body's temperature?
Korotkoff sounds Phase II Swishing
140-159/90-99
the palpation method is used. put cuff over arm - feel the radial point to get the systolic pressure you cant get the diastolic this way.
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.

32. Increased or rapid breathing results from te presence of fever and a number or diseases. breathing rate increased about 4 breaths for each degree increase in temperature.
Acute anxiety stimulate the nervous system - raising the pulse.
higher
Tachypnea
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes

33. Average pulse rate for an adult
bradypnea
72 bpm
orthostatic hypertension
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients

34. How is pulse best found?
bradycardia
by placing the flat part of the first fingers against the tendon - or cord - on the thumb inside of the inner wrist and ten rolling the fingers slightly outward into the little trough on the thumb inside the wrist.
apnea
Stimulants increase the pulse rate. Depressants decrease the pulse rate.

35. Stress & emotions. BP?
higher
the blood pressure will rise in order to push the blood along.
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
1) ventilation - Which is the movement of air in and out of the lung. 2) dispersion of air throughout the bronchial tree of the lungs; 3) diffusion of oxygen and carbon dioxide molecules across the alveolar membranes; 4) perfusion - the movement of b

36. The temperature is continuously elevated with less than 1 degree of variation within a 24-hour period.
constant
^160/^100
The emotions increase hormone secretion - and the body activities required for this increase heat production.
from drug therapy - a neurologic problem or dehydration.

37. Whats the best position to take a rectal temperature?
the blood pressure will rise in order to push the blood along.
blood pressure is lowest in the morning. and higher in the afternoone
left Sims position
higher

38. Abrupt decline in fever
Crisis
It increases to push the blood through more rigid pathways.
Cardiac Output
Acute anxiety stimulate the nervous system - raising the pulse.

39. Fever above 100.2 F
12-20
when it is difficult to find or to count the radial pulse - or for patients with heart conditions for one full minute by placing stethoscope on the heart to count for a full minute.
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
pyrexia

40. Pulse above 100 beats per minute
apnea
Biot's respirations
tachycardia
systolic pressure indicated by faint - clear sound that gradually grow louder.

41. When the vascular walls lose elasticity - as with arteriosclerosis and aging what happens to BP?
72 bpm
It increases to push the blood through more rigid pathways.
bradypnea
140-159/90-99

42. Stage 1 hypertension
dyspnea
Pedal pulse
Biot's respirations
140-159/90-99

43. If the cardiac output falls what will happen to the BP?
by placing the flat part of the first fingers against the tendon - or cord - on the thumb inside of the inner wrist and ten rolling the fingers slightly outward into the little trough on the thumb inside the wrist.
72 bpm
It will also fall
Respiration

44. What happens whens vasoconstriction causes peripheral vascular resistance to rise?
the blood pressure will rise in order to push the blood along.
cardiac patients or patients who have had rectal surgery.
Core Temperature
Sinoatrial node (SA NODE)

45. What happens to the blood if overhydration occurs?
+2
Blood pressure increases because there is more volume of blood in the vascular system.
left Sims position
Vascular resistance drops and the blood pressure decreases

46. Lobes in the lungs?
Sinoatrial node (SA NODE)
Apical
3 in the right lung and 2 lobes in the left
carotid

47. An example of a nursing diagnoses
3 in the right lung and 2 lobes in the left
97.5 to 99.5
Hyperthermia related to infection or excessive heat exposure
Diastolic pressure

48. Side of wrist
place the thermometer in the center of the patients dry axilla. Ask patient to hold the arm tightly against the chest. Leave in place 3-8 minutes.
Radial
remittent
pyrogens

49. Weak and may be irregular
120/70
hypotension
thready
Acute anxiety stimulate the nervous system - raising the pulse.

50. Heat is lost from the body by evaporation. resulting in a daily loss of 800mL of water from skin and lungs.
Evaporation
1) ventilation - Which is the movement of air in and out of the lung. 2) dispersion of air throughout the bronchial tree of the lungs; 3) diffusion of oxygen and carbon dioxide molecules across the alveolar membranes; 4) perfusion - the movement of b
BMR
96.5 to 97.5

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Measuring Vital Signs

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