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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. By measuring the blood pressure you obtain vital info about what?
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
cardiac patients or patients who have had rectal surgery.
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Stertor

2. Average pulse rate for an adult
hypoxia
Temporal
72 bpm
Diaphoresis

3. How does menstrual cycle and pregnancy raise the body's temperature?
tachycardia
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
Axillary.

4. A sudden change or muffling of the sound. (indicates diastolic pressure in children and some adults)
Korotkoff sounds Phase IV: Muffling
96.5 to 97.5
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
shallow or slow breathing

5. Sex BP?
Nursing interventions to reduce fever
Blood pressure increases because there is more volume of blood in the vascular system.
males have higher bp - until menopause then they are the same
shallow or slow breathing

6. Strong and regular ( even beats wit moderate force)
+2
bradypnea
Biot's
uncooperative patient - children - combative patients - dementia

7. Taking axillary temperature
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.
hypoxia
thready
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.

8. Does the respiration rate increase or decrease during fever?
Increases as body tries to remove excess heat
Sinoatrial node (SA NODE)
It increases to push the blood through more rigid pathways.
Eupnea

9. The rate at which heat is produced when the body is at rest.
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.
BMR
in the alveoli - tiny thin-walled sacs
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.

10. Blood pressure for any adult should be no higher than
120/80
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
lysis
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.

11. Korotkoff sounds Ausculatatory gap:
Conduction
systolic pressure indicated by faint - clear sound that gradually grow louder.
ausculatation
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients

12. How does disease increase the body's temperature?
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Pulse pressure
about 1 degree higher than oral temperatures

13. How do you measure the apical pulse?
120/80
Apical
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.

14. Fever above 100.2 F
Stroke Volume
the blood pressure will rise in order to push the blood along.
Dorsalis pedis
pyrexia

15. Snoring sound produced when patients are unable to cough up secretions from the trachea or bronchi
Stertor
+1
BMR
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.

16. 1st stage of fever is?
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
bradycardia
+2
Respiration

17. How should respirations be counted?
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
palpate
20-30

18. Newborn
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
about 1 degree higher than oral temperatures
30-80
in the alveoli - tiny thin-walled sacs

19. Whats the best position to take a rectal temperature?
from drug therapy - a neurologic problem or dehydration.
20-30
3 in the right lung and 2 lobes in the left
left Sims position

20. Heart
Korotkoff sounds Phase III: Knocking
absent
Apical
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.

21. The pressure wave causing te arterial walls in the vascular system each time the heart contracts to force blood into an already full aorta.
Pulse
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
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
arrhythmia

22. The maximum pressure exerted on the artery during left ventricular contraction.
Systolic pressure
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
hypoxia
+1

23. When should rectal temperatures be used?
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
Tall - slender people mayy ave a slower pulse rate than short - stout persons
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
higher

24. Crowing sound on inspiration caused by obstruction of the upper air passages - as occurs in croup or laryngitis
Sinoatrial node (SA NODE)
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
stridor
Kussmaul's respiration

25. People most at risk for hypertension
wheeze
Tachypnea
men - African Americans - under a lot of stress - obese
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.

26. Why would patients experience orthostatic hypotenstion?
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
popliteal
from drug therapy - a neurologic problem or dehydration.
arrhythmia

27. Gradual return to a normal temperature
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Korotkoff sounds Phase III: Knocking
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.
lysis

28. Side of wrist
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
systolic pressure indicated by faint - clear sound that gradually grow louder.
Radial
about 1 degree higher than oral temperatures

29. What should you do if you cannot determine BP by ausculation?
Diastolic pressure
oximeter
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
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. Absence of breathing
apnea
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
bradycardia

31. Elevated temperature
fever
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
60 to 70 mL
oximetry

32. Inside ankle
Hyperventilation
Tachypnea
Posterior tibial
low

33. Korotkoff sounds Phase I: Tapping
Korotkoff sounds Phase II Swishing
systolic pressure indicated by faint - clear sound that gradually grow louder.
Radial
in the alveoli - tiny thin-walled sacs

34. When the vascular walls lose elasticity - as with arteriosclerosis and aging what happens to BP?
orthostatic hypertension
It increases to push the blood through more rigid pathways.
the rate - the rhythm - and volume
^160/^100

35. What happens when vasodilation occurs?
thready
96.5 to 97.5
Vascular resistance drops and the blood pressure decreases
Cardiac Output

36. The exchange of oxygen and carbon dioxide in the lungs and tissues and is initiated by the act of breathing.
Respiration
pyrogens
72 bpm
Crisis

37. Gas exchange in the blood occurs where?
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.
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
in the alveoli - tiny thin-walled sacs
hyperoxia

38. Top of left foot
higher
Cheyenne-Stokes
blood pressure is lowest in the morning. and higher in the afternoone
Dorsalis pedis

39. 3rd stage of fever?
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
20-30
orthostatic hypertension
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.

40. 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.
wheeze
the blood pressure will rise in order to push the blood along.
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.

41. The difference between the systolic pressure and the diastolic pressure
about 1 degree lower than oral temperatures
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
Pulse pressure
Femoral

42. Bend of knee
Core Temperature
uncooperative patient - children - combative patients - dementia
absent
popliteal

43. What patients should not use a glass thermometer orally?
Crisis
uncooperative patient - children - combative patients - dementia
The pulse rate gradually diminishes from birth to adulthood
raises BP.

44. Stage 1 hypertension
Sinoatrial node (SA NODE)
The emotions increase hormone secretion - and the body activities required for this increase heat production.
140-159/90-99
Nursing interventions to reduce fever

45. Feel
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
It will also fall
palpate
remittent

46. Diurnal variation BP?
Rhonchi
blood pressure is lowest in the morning. and higher in the afternoone
stridor
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.

47. The volume of blood pushed into the aorta per heartbeat.
Core Temperature
tachycardia
Brachial
Stroke volume

48. Air movemtn causes heat to be transferred from the skin to the air molecules.
hypoxia
Stroke Volume
Axillary.
Convection

49. Those at risk for hypothermia include
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
Brachial
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.
oximetry

50. While measuring the BP certain sounds may be heard that relate to the effect of the blood pressure cuff on the arterial wall.
Stroke Volume
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
Korotkoff sounds Phase III: Knocking
Korotkoff sounds