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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.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Difference between the apical and radial pulse - this requires two people to count the radial and apicial pulses at the same time to determine whether there is a what?
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
Korotkoff sounds Phase II Swishing
+3
hyperoxia

2. Barely palpable
Feeble
Crisis
Dorsalis pedis
postoperative patients wo have been cooled during surgery - newborn infants whose skin is exposed to cool room temperatures - elderly or debiliated patients - and those exposed to cold temperatures for prolonged periods.

3. Abrupt decline in fever
temperature - pulse - respiration - blood pressure - and pain level.
Crisis
Respiration
Biot's

4. Shock - hemorrhage - low cardiac output - inadequate volume of blood?
low BP
Relapsing
The pulse rate gradually diminishes from birth to adulthood
Posterior tibial

5. Stage 1 hypertension
Temporal
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
hyperoxia
140-159/90-99

6. respirations become faster and deeper - then slower and shallower wit a period of apnea - called the death rattle.
Cheyenne-Stokes
120/80
raises BP.
16-20

7. High oxygen
Tall - slender people mayy ave a slower pulse rate than short - stout persons
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
hyperoxia

8. An example of nursing planning
120/80
Systolic pressure
Temperature will remain below 102 degrees with use of hypothermia blanket
Kussmaul's respiration

9. Healthly adult
stridor
bradycardia
12-20
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.

10. How do you measure the apical pulse?
Korotkoff sounds Phase IV: Muffling
remittent
determine if the patient has a known heart arrhythmia - perform hand hygiene - expose the left chest - warm the stethoscope in hand for a min or 2 - locate the apex of the heart by palpating for the 5th intercostal space at the midclavicular line. li
males have higher bp - until menopause then they are the same

11. Side of wrist
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
Radial
It increases to push the blood through more rigid pathways.
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.

12. How should baby's temperature be taken?
oximetry
Axillary.
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.
orthostatic hypertension

13. Korotkoff sounds Phase I: Tapping
systolic pressure indicated by faint - clear sound that gradually grow louder.
wheeze
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
Korotkoff sounds Phase III: Knocking

14. The maximum pressure exerted on the artery during left ventricular contraction.
Systolic pressure
Korotkoff sounds
Korotkoff sounds Phase IV: Muffling
intermittent

15. How does menstrual cycle and pregnancy raise the body's temperature?
stridor
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
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.
low BP

16. Substances tat cause fever
Posterior tibial
pyrogens
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
120-139/80-89

17. The difference between the systolic pressure and the diastolic pressure
hypoxia
Pulse pressure
Axillary.
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.

18. Newborn
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
Respiration
30-80

19. An example of a nursing diagnoses
the rate - the rhythm - and volume
Korotkoff sounds Phase II Swishing
left Sims position
Hyperthermia related to infection or excessive heat exposure

20. When is apicial pulse used?
the blood pressure will rise in order to push the blood along.
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.
in the alveoli - tiny thin-walled sacs
30-80

21. How is pulse best found?
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.
Korotkoff sounds Phase V: Silence
120/80
Korotkoff sounds Phase IV: Muffling

22. Measurement of oxygen
Cheyenne-Stokes
Temperature will remain below 102 degrees with use of hypothermia blanket
apnea
oximetry

23. How does emotional stress raise the body's temperature?
97.5 to 99.5
hypoxemia
Pulse
The emotions increase hormone secretion - and the body activities required for this increase heat production.

24. Obtaining the correct size for a cuff for BP?
Pulse pressure
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
hypertension
Dorsalis pedis

25. Both strong and weak beats occur within 1 minute
uncooperative patient - children - combative patients - dementia
Irregular
Acute anxiety stimulate the nervous system - raising the pulse.
men - African Americans - under a lot of stress - obese

26. What affects does aging do to the heart rate?

27. What affects does aging do to the blood pressure?
Feeble
popliteal
the effectiveness of the heart contractions - the amount of blood in the system - and the presence of any obstruction or interference of blood to the blood vessels
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.

28. The temperature is continuously elevated with less than 1 degree of variation within a 24-hour period.
Crisis
Stertor
constant
Apical

29. Increased rate and depth with panting and long grunting exhalation. Often seen with patients with acidosis and renal failure.

30. Axillary temperature are
96.5 to 97.5
crackles
Temporal
about 1 degree lower than oral temperatures

31. Elderly respiration
16-20
Feeble
It increases to push the blood through more rigid pathways.
Stimulants increase the pulse rate. Depressants decrease the pulse rate.

32. Does the respiration rate increase or decrease during fever?
Apical
Korotkoff sounds Phase II Swishing
Increases as body tries to remove excess heat
arrhythmia

33. Irregular pulse - a period of normal rhythm broken by periods of irregularity or skipped beats.
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
arrhythmia
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
Eupnea

34. Korotkoff sounds Ausculatatory gap:
Posterior tibial
Korotkoff sounds Phase IV: Muffling
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.

35. Taking axillary temperature
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
Biot's respirations
Stertor
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.

36. The temperature falls to normal and then rises again in a repeating pattern.
Acute anxiety stimulate the nervous system - raising the pulse.
Relapsing
about 1 degree lower than oral temperatures
96.5 to 97.5

37. The temperature of the deep tissues of the body
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
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.
Core Temperature

38. Louder knocking sound that occurs wit each heartbeat
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
+1
Stertor
Korotkoff sounds Phase III: Knocking

39. The rate at which heat is produced when the body is at rest.
Cheyenne-Stokes
Conduction
BMR
Cardiac Output

40. Blood pressure for any adult should be no higher than
in the alveoli - tiny thin-walled sacs
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
120/80
^160/^100

41. Average blood pressure should be
Femoral
temperature - pulse - respiration - blood pressure - and pain level.
ausculatation
120/70

42. How do emotions increase the pulse rate?
Acute anxiety stimulate the nervous system - raising the pulse.
72 bpm
palpate
The pulse rate gradually diminishes from birth to adulthood

43. 3 yr old
20-30
Irregular
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.
The pulse rate gradually diminishes from birth to adulthood

44. Rectal temperature are
Korotkoff sounds Phase III: Knocking
about 1 degree higher than oral temperatures
carotid
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.

45. Whisting sound of air forced past a partial obstruction - as found in asthma or emphysema.
60 to 70 mL
+2
wheeze
Hypothermia

46. Groin area
Femoral
left Sims position
thready
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.

47. Pulse above 100 beats per minute
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
tachycardia
the rate - the rhythm - and volume
Korotkoff sounds Phase II Swishing

48. Fever above 100.2 F
pyrexia
Korotkoff sounds Phase III: Knocking
Biot's
crackles

49. BP at or lower 90/60.
Increases as body tries to remove excess heat
popliteal
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
hypotension

50. No pulse palpable or heard on ausculation
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
BMR
absent
Onset - which may occur gradually or suddenly. the body responds to a pyrogen by trying to conserve and manufacture heat to raise the set point for core temperature. The person will feel cold - and will add clothes or covers - curl up in a ball - and