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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. Excessive sweat production
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
Diaphoresis
absent
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.

2. Prehypertension
120-139/80-89
bradycardia
Evaporation
Conduction

3. Pulse above 100 beats per minute
tachycardia
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
low BP
Korotkoff sounds Phase III: Knocking

4. respirations become faster and deeper - then slower and shallower wit a period of apnea - called the death rattle.
Brachial
Convection
Cheyenne-Stokes
about 1 degree higher than oral temperatures

5. Elderly respiration
16-20
wheeze
the rate - the rhythm - and volume
Rhonchi

6. How does physical exercise raise the body's temperature?
left Sims position
Biot's
Kussmaul's respiration
It uses large muscles in the body - which create body heat by burning up the glucose and fat in the tissues - muscle action generates heat and core temperature rises.

7. An example of a nursing diagnoses
Feeble
the lungs
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.
Hyperthermia related to infection or excessive heat exposure

8. How does menstrual cycle and pregnancy raise the body's temperature?
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
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
raises BP.
Sinoatrial node (SA NODE)

9. Heat is lost from the body by evaporation. resulting in a daily loss of 800mL of water from skin and lungs.
Evaporation
BMR
about 1 degree higher than oral temperatures
remittent

10. Side of neck
carotid
hypoxia
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.

11. 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.
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Nursing interventions to reduce fever
palpate

12. When the heart contracts How many mLs of blood is propelled into the aorta?
60 to 70 mL
Rhonchi
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.
Blood pressure increases because there is more volume of blood in the vascular system.

13. How does emotional stress raise the body's temperature?
When an accurate temperature cant be obtained orally and a tympanic or temporal artery thermometer are not available. It may be used when there is nasal congestion or there has been nasal or oral surgery - the patient is unable to keep their mouth cl
^160/^100
bradypnea
The emotions increase hormone secretion - and the body activities required for this increase heat production.

14. Bend of knee
intermittent
Blood pressure increases because there is more volume of blood in the vascular system.
popliteal
about 1 degree lower than oral temperatures

15. Inside ankle
16-20
96.5 to 97.5
about 1 degree higher than oral temperatures
Posterior tibial

16. This affects the character of the pulse.
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.
+2
Stroke Volume
Blood pressure increases because there is more volume of blood in the vascular system.

17. Weak and may be irregular
Hyperthermia related to infection or excessive heat exposure
thready
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.

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

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19. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
Rhonchi
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
It will also fall
Korotkoff sounds Phase II Swishing

20. The pulse rate multiplied by the stroke volume. This is the amount of blood pumped by the left ventricle in 1 minute. Averaging at about 5mL per minute.
Blood pressure increases because there is more volume of blood in the vascular system.
Brachial
Cardiac Output
Diaphoresis

21. What will happen in febrile stage if temperature is very high or temperature stays for a long amount of time?
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.
about 1 degree higher than oral temperatures
16-20
Irregular

22. The temperature is continuously elevated with less than 1 degree of variation within a 24-hour period.
constant
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 III: Knocking
Korotkoff sounds

23. Healthly adult
^160/^100
Relapsing
12-20
Cheyenne-Stokes

24. What affects does aging do to the respiratory rate?
Cheyenne-Stokes
shallow or slow breathing
96.5 to 97.5
It may rise slightly as decreases in vital capacity and respiratory reserve occur.

25. 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
+2
Axillary.
Pedal pulse
hypoxia

26. How is pulse best found?
Tachypnea
constant
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.
crackles

27. How does external respiration occur?
Korotkoff sounds Phase II Swishing
Korotkoff sounds Phase V: Silence
palpate
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

28. Normal body temperature ranges?
low
Acute anxiety stimulate the nervous system - raising the pulse.
97.5 to 99.5
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

29. Carbon dioxide is carried as bicarbonate ion in the blood until it reaches where?
the lungs
Hyperventilation
temperature - pulse - respiration - blood pressure - and pain level.
Evaporation

30. 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.
Tachypnea
uncooperative patient - children - combative patients - dementia
Blood pressure increases because there is more volume of blood in the vascular system.
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

31. State of insufficient oxygen
stridor
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
hypoxia
When an accurate temperature cant be obtained orally and a tympanic or temporal artery thermometer are not available. It may be used when there is nasal congestion or there has been nasal or oral surgery - the patient is unable to keep their mouth cl

32. The maximum pressure exerted on the artery during left ventricular contraction.
Systolic pressure
in the alveoli - tiny thin-walled sacs
The pulse rate gradually diminishes from birth to adulthood
Irregular

33. Risk for prolonged hypertension
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
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
thready

34. What happens when vasodilation occurs?
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
in the alveoli - tiny thin-walled sacs
Vascular resistance drops and the blood pressure decreases
Hyperthermia related to infection or excessive heat exposure

35. Both strong and weak beats occur within 1 minute
BMR
about 1 degree higher than oral temperatures
absent
Irregular

36. The difference between the systolic pressure and the diastolic pressure
lysis
Cheyenne-Stokes
Pulse pressure
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.

37. Drop in blood pressure when arising to a standing position.
the blood pressure will rise in order to push the blood along.
The emotions increase hormone secretion - and the body activities required for this increase heat production.
orthostatic hypertension
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.

38. While measuring the BP certain sounds may be heard that relate to the effect of the blood pressure cuff on the arterial wall.
wheeze
Korotkoff sounds
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
Rhonchi

39. Alternating rise and fall of the temperature.
The emotions increase hormone secretion - and the body activities required for this increase heat production.
3 in the right lung and 2 lobes in the left
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
intermittent

40. What should you do if you cannot determine BP by ausculation?
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.
30-80
oximeter
It will also fall

41. Breathing is an involuntary automatic function controlled by the respiratory center located where?
Dorsalis pedis
Pons and Medulla of the brainstem
higher
Apical

42. Irregular pulse - a period of normal rhythm broken by periods of irregularity or skipped beats.
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
palpate
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
arrhythmia

43. When the vascular walls lose elasticity - as with arteriosclerosis and aging what happens to BP?
Eupnea
Pedal pulse
It increases to push the blood through more rigid pathways.
systolic pressure indicated by faint - clear sound that gradually grow louder.

44. What happens to the blood if overhydration occurs?
Blood pressure increases because there is more volume of blood in the vascular system.
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.
Eupnea
Stertor

45. Symptoms of hypoxia
raises BP.
palpate
pyrogens
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds

46. High BP
hypertension
Korotkoff sounds Phase IV: Muffling
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
stridor

47. Top of left foot
fever
about 1 degree lower than oral temperatures
Dorsalis pedis
Korotkoff sounds

48. 1st stage of fever is?
pyrexia
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
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
from drug therapy - a neurologic problem or dehydration.

49. Measurement of oxygen
oximetry
apnea
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.
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

50. How does age affect pulse?
3 in the right lung and 2 lobes in the left
Femoral
from drug therapy - a neurologic problem or dehydration.
The pulse rate gradually diminishes from birth to adulthood