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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. Carbon dioxide is carried as bicarbonate ion in the blood until it reaches where?
16-20
the lungs
Hyperthermia related to infection or excessive heat exposure
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.

2. Head injury or any increased intracranial pressure will depress the respiratory center and result in?
uncooperative patient - children - combative patients - dementia
120/70
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
shallow or slow breathing

3. Macine that measures oxygen in the blood by determining the percentage of hemoglobin that is bound with oxygen.
oximeter
Core Temperature
low BP
Increases as body tries to remove excess heat

4. Difficult and labored breathing - can often be accompanied by flared nostrils - anxious appearance - and statements such as I cant get enough air.
dyspnea
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
Evaporation
Cardiac Output

5. How do emotions increase the pulse rate?
Brachial
Acute anxiety stimulate the nervous system - raising the pulse.
palpate
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.

6. Why would patients experience orthostatic hypotenstion?
about 1 degree lower than oral temperatures
apnea
from drug therapy - a neurologic problem or dehydration.
Korotkoff sounds Phase III: Knocking

7. Taking axillary temperature
Respiration
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
remittent
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.

8. Decreased levels of oxygen in the blood - often seen in patients wo are under medical sedation - who are recovering from anesthesia or abdominal surgery - or who are in a weak or debiliated condition.
Cardiac Output
Hyperventilation
about 1 degree higher than oral temperatures
hypoxemia

9. Gradual return to a normal temperature
palpate
Pedal pulse
lysis
raises BP.

10. Side of forehead
Eupnea
Temporal
Dorsalis pedis
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.

11. The volume of blood pushed into the aorta per heartbeat.
Diastolic pressure
Axillary.
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
Stroke volume

12. 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
It increases to push the blood through more rigid pathways.
97.5 to 99.5
Stertor

13. Bend of knee
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
temperature - pulse - respiration - blood pressure - and pain level.
popliteal
Tachypnea

14. Feel
Kussmaul's respiration
the rate - the rhythm - and volume
Acute anxiety stimulate the nervous system - raising the pulse.
palpate

15. When should rectal temperatures NOT be used?
cardiac patients or patients who have had rectal surgery.
Korotkoff sounds Phase II Swishing
Hyperthermia related to infection or excessive heat exposure
140-159/90-99

16. Whisting sound of air forced past a partial obstruction - as found in asthma or emphysema.
wheeze
Temporal
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
constant

17. Risk for prolonged hypertension
97.5 to 99.5
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
ausculatation
120/80

18. 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.
Cardiac Output
intermittent
Pedal pulse

19. How is shock caused?
Tall - slender people mayy ave a slower pulse rate than short - stout persons
hypoxia
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
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.

20. 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
about 1 degree higher than oral temperatures
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
Conduction

21. Full and bounding (even beats wit strong force)
+3
+1
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
Femoral

22. 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.
ausculatation
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
arrhythmia

23. Does the respiration rate increase or decrease during fever?
Feeble
96.5 to 97.5
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
Increases as body tries to remove excess heat

24. What affects does aging do to the blood pressure?
crackles
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
constant
Cheyenne-Stokes

25. 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.
thready
72 bpm
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.

26. How does increased body temperature increase the pulse?
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
Systolic pressure
oximeter
+2

27. Snoring sound produced when patients are unable to cough up secretions from the trachea or bronchi
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.
Irregular
Diaphoresis
Stertor

28. Korotkoff sounds Ausculatatory gap:
Nursing interventions to reduce fever
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
Increases as body tries to remove excess heat
Cheyenne-Stokes

29. Top of left foot
constant
Dorsalis pedis
temperature - pulse - respiration - blood pressure - and pain level.
Increases as body tries to remove excess heat

30. How cardiac contractions are normally initiated by the electrical impules emerging from what?
Sinoatrial node (SA NODE)
+1
uncooperative patient - children - combative patients - dementia
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients

31. By measuring the blood pressure you obtain vital info about what?
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
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
Cheyenne-Stokes
thready

32. The difference between the systolic pressure and the diastolic pressure
Pulse pressure
hypoxia
hyperoxia
the lungs

33. 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.
Korotkoff sounds
crackles
hyperoxia
It may rise slightly as decreases in vital capacity and respiratory reserve occur.

34. Lobes in the lungs?
3 in the right lung and 2 lobes in the left
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
Biot's respirations
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.

35. Diurnal variation BP?
Apical
blood pressure is lowest in the morning. and higher in the afternoone
bradypnea
Stimulants increase the pulse rate. Depressants decrease the pulse rate.

36. What patients should not use a glass thermometer orally?
Systolic pressure
uncooperative patient - children - combative patients - dementia
The pulse rate gradually diminishes from birth to adulthood
Rhonchi

37. Fast - deep respirations with abrupt pauses

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38. How does size affect pulse?
Korotkoff sounds Phase III: Knocking
Tall - slender people mayy ave a slower pulse rate than short - stout persons
blood pressure is lowest in the morning. and higher in the afternoone
Evaporation

39. When is apicial pulse used?
hypoxia
Korotkoff sounds
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
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.

40. The average temperature in the older adult
Apical
Systolic pressure
It will also fall
96.5 to 97.5

41. The temperature of the deep tissues of the body
97.5 to 99.5
remittent
Core Temperature
tachycardia

42. Absence of breathing
hypertension
hypoxia
60 to 70 mL
apnea

43. Elevated temperature
orthostatic hypertension
Posterior tibial
fever
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.

44. Irregular pulse - a period of normal rhythm broken by periods of irregularity or skipped beats.
Hyperventilation
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
arrhythmia
Systolic pressure

45. 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
Hyperventilation
raises BP.
Korotkoff sounds Phase III: Knocking
Hypothermia

46. 3rd stage of fever?
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
stridor

47. Bend of elbow
higher
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
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
Brachial

48. When the heart contracts How many mLs of blood is propelled into the aorta?
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.
pyrogens
60 to 70 mL
Pedal pulse

49. Signs and symptoms of shock
Eupnea
Temporal
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
oximeter

50. Disappearance of sound. (marks diastolic pressure in adults)
Korotkoff sounds Phase V: Silence
stridor
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
palpate