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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. This affects the character of the pulse.
16-20
blood pressure is lowest in the morning. and higher in the afternoone
Stroke Volume
Rhonchi

2. Encourage a large fluid intake - lower room temperature - increase air circulation - remove items of clothes - control or reduce the amount of body activity - carry out physicians orders
systolic pressure indicated by faint - clear sound that gradually grow louder.
Sinoatrial node (SA NODE)
hypoxia
Nursing interventions to reduce fever

3. Both strong and weak beats occur within 1 minute
Korotkoff sounds Phase V: Silence
Irregular
BMR
Cheyenne-Stokes

4. What are the 5 vital signs?
temperature - pulse - respiration - blood pressure - and pain level.
20-30
Hyperthermia related to infection or excessive heat exposure
Korotkoff sounds Phase III: Knocking

5. How does menstrual cycle and pregnancy raise the body's temperature?
arrhythmia
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
remittent

6. When should rectal temperatures NOT be used?
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
cardiac patients or patients who have had rectal surgery.
Rhonchi
higher

7. 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
97.5 to 99.5
the blood pressure will rise in order to push the blood along.
lysis
Pedal pulse

8. Heart
Blood pressure increases because there is more volume of blood in the vascular system.
Diaphoresis
fever
Apical

9. The rate at which heat is produced when the body is at rest.
Korotkoff sounds Phase III: Knocking
Pulse
hypoxia
BMR

10. Weak and regular (even beats wit poor force)
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.
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
+1
left Sims position

11. Bend of elbow
96.5 to 97.5
Brachial
Korotkoff sounds Phase II Swishing
shallow or slow breathing

12. Absence of breathing
apnea
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
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.
the blood pressure will rise in order to push the blood along.

13. A normal - relaxed breathing pattern
Eupnea
hyperoxia
Acute anxiety stimulate the nervous system - raising the pulse.
120-139/80-89

14. How does increased body temperature increase the pulse?
120-139/80-89
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
16-20
120/70

15. Excessive sweat production
+3
Tachypnea
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
Diaphoresis

16. Groin area
the rate - the rhythm - and volume
Femoral
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
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.

17. right arm vs. left arm/ arm vs. leg BP?
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.
12-20
Nursing interventions to reduce fever
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.

18. Symptoms of hypoxia
140-159/90-99
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
Rhonchi
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.

19. Breathing is an involuntary automatic function controlled by the respiratory center located where?
+2
3 in the right lung and 2 lobes in the left
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
Pons and Medulla of the brainstem

20. 3 yr old
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Korotkoff sounds Phase IV: Muffling
20-30
Vascular resistance drops and the blood pressure decreases

21. Abnormal - nonmusical sound heard on ausculation of the lungs during inspiration; also called rales. Sound like hair rubbed between the fingers next to the ears.
fever
Core Temperature
Cardiac Output
crackles

22. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
absent
oximetry
Rhonchi
dyspnea

23. Head injury BP?
Korotkoff sounds Phase II Swishing
raises BP.
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
absent

24. Difficult and labored breathing - can often be accompanied by flared nostrils - anxious appearance - and statements such as I cant get enough air.
about 1 degree higher than oral temperatures
96.5 to 97.5
dyspnea
Pulse pressure

25. Healthly adult
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.
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
12-20
The pulse rate gradually diminishes from birth to adulthood

26. Barely palpable
bradycardia
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.
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Feeble

27. People most at risk for hypertension
16-20
Biot's
Temporal
men - African Americans - under a lot of stress - obese

28. High oxygen
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
hyperoxia
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
bradycardia

29. Slow and shallow breathing - leads to hypoxemia.
bradypnea
Korotkoff sounds Phase IV: Muffling
oximeter
Sinoatrial node (SA NODE)

30. Top of left foot
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.
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Dorsalis pedis
Rhonchi

31. What affects does aging do to the blood pressure?
Evaporation
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
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
Hypothermia

32. Louder knocking sound that occurs wit each heartbeat
The emotions increase hormone secretion - and the body activities required for this increase heat production.
30-80
Korotkoff sounds Phase III: Knocking
Eupnea

33. Pulse lower than 60 beats per minute
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
Biot's
Femoral
bradycardia

34. What happens when vasodilation occurs?
stridor
Pons and Medulla of the brainstem
Vascular resistance drops and the blood pressure decreases
Stroke Volume

35. Stage 2 hypertension
Temporal
The pulse rate gradually diminishes from birth to adulthood
crackles
^160/^100

36. Stress & emotions. BP?
Tall - slender people mayy ave a slower pulse rate than short - stout persons
60 to 70 mL
higher
Systolic pressure

37. Strong and regular ( even beats wit moderate force)
+2
Acute anxiety stimulate the nervous system - raising the pulse.
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.
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.

38. Lobes in the lungs?
intermittent
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.
Cheyenne-Stokes
3 in the right lung and 2 lobes in the left

39. Average pulse rate for an adult
tachycardia
hypotension
Irregular
72 bpm

40. How does age affect pulse?
The pulse rate gradually diminishes from birth to adulthood
males have higher bp - until menopause then they are the same
men - African Americans - under a lot of stress - obese
Blood pressure increases because there is more volume of blood in the vascular system.

41. 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.
the blood pressure will rise in order to push the blood along.
Cardiac Output
in the alveoli - tiny thin-walled sacs
Blood pressure increases because there is more volume of blood in the vascular system.

42. Side of wrist
Korotkoff sounds Phase III: Knocking
Radial
Hyperthermia related to infection or excessive heat exposure
Pulse

43. Low oxygen
Axillary.
hypoxia
Pedal pulse
It may rise slightly as decreases in vital capacity and respiratory reserve occur.

44. A sudden change or muffling of the sound. (indicates diastolic pressure in children and some adults)
120-139/80-89
72 bpm
Korotkoff sounds Phase IV: Muffling
raises BP.

45. How does external respiration occur?
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
oximeter
Irregular
Dorsalis pedis

46. 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
The emotions increase hormone secretion - and the body activities required for this increase heat production.
The pulse rate gradually diminishes from birth to adulthood
Hyperventilation
Feeble

47. Crowing sound on inspiration caused by obstruction of the upper air passages - as occurs in croup or laryngitis
Pons and Medulla of the brainstem
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
12-20
stridor

48. When the vascular walls lose elasticity - as with arteriosclerosis and aging what happens to BP?
It increases to push the blood through more rigid pathways.
Conduction
Core Temperature
Convection

49. Gradual return to a normal temperature
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
Tachypnea
lysis
Tall - slender people mayy ave a slower pulse rate than short - stout persons

50. Irregular pulse - a period of normal rhythm broken by periods of irregularity or skipped beats.
arrhythmia
carotid
Respiration
Kussmaul's respiration

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Measuring Vital Signs

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