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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. No pulse palpable or heard on ausculation
absent
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.
Pulse
palpate

2. Disappearance of sound. (marks diastolic pressure in adults)
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
Korotkoff sounds Phase V: Silence
blood pressure is lowest in the morning. and higher in the afternoone
low BP

3. Adolescent
Eupnea
It will also fall
16-20
Blood pressure increases because there is more volume of blood in the vascular system.

4. Weak and regular (even beats wit poor force)
orthostatic hypertension
+1
Tachypnea
oximetry

5. Absence of breathing
apnea
Pons and Medulla of the brainstem
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.
120/70

6. Excessive sweat production
constant
Irregular
orthostatic hypertension
Diaphoresis

7. How should respirations be counted?
Korotkoff sounds
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
apnea
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.

8. How does the time of day (circadian rhythm) affect the body's temperature?

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9. When should rectal temperatures NOT be used?
cardiac patients or patients who have had rectal surgery.
constant
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
120-139/80-89

10. Enviromental temperature BP?
Evaporation
thready
cardiac patients or patients who have had rectal surgery.
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.

11. The pressure wave causing te arterial walls in the vascular system each time the heart contracts to force blood into an already full aorta.
about 1 degree lower than oral temperatures
Pulse
absent
Temporal

12. Average pulse rate for an adult
72 bpm
Diaphoresis
Biot's respirations
the blood pressure will rise in order to push the blood along.

13. When warm skin touches a cool object - heat is lost to the object.
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.
Conduction
males have higher bp - until menopause then they are the same
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients

14. BP at or lower 90/60.
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
carotid
Brachial
hypotension

15. 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.
Nursing interventions to reduce fever
low
about 1 degree higher than oral temperatures
Tachypnea

16. The exchange of oxygen and carbon dioxide in the lungs and tissues and is initiated by the act of breathing.
120/70
males have higher bp - until menopause then they are the same
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.
Respiration

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

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18. Feel
systolic pressure indicated by faint - clear sound that gradually grow louder.
hypoxia
the lungs
palpate

19. Both strong and weak beats occur within 1 minute
low BP
Irregular
120-139/80-89
hypoxemia

20. Risk for prolonged hypertension
The pulse rate gradually diminishes from birth to adulthood
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
temperature - pulse - respiration - blood pressure - and pain level.
stridor

21. State of insufficient oxygen
temperature - pulse - respiration - blood pressure - and pain level.
systolic pressure indicated by faint - clear sound that gradually grow louder.
crackles
hypoxia

22. respirations become faster and deeper - then slower and shallower wit a period of apnea - called the death rattle.
Brachial
140-159/90-99
Cheyenne-Stokes
Korotkoff sounds Phase V: Silence

23. Top of left foot
Dorsalis pedis
the lungs
bradycardia
72 bpm

24. 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
Stertor
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.

25. An example of a nursing diagnoses
Hyperthermia related to infection or excessive heat exposure
palpate
higher
in the alveoli - tiny thin-walled sacs

26. The difference between the systolic pressure and the diastolic pressure
^160/^100
from drug therapy - a neurologic problem or dehydration.
Stroke Volume
Pulse pressure

27. Whisting sound of air forced past a partial obstruction - as found in asthma or emphysema.
wheeze
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
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

28. Whats the best position to take a rectal temperature?
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.
96.5 to 97.5
ausculatation
left Sims position

29. Strong and regular ( even beats wit moderate force)
Nursing interventions to reduce fever
+2
men - African Americans - under a lot of stress - obese
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.

30. Average blood pressure should be
in the alveoli - tiny thin-walled sacs
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
120/70
Korotkoff sounds Phase V: Silence

31. 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?
apnea
Increases as body tries to remove excess heat
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
120/80

32. 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.
Convection
Pons and Medulla of the brainstem
hypoxemia
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.

33. Does the respiration rate increase or decrease during fever?
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.
BMR
Increases as body tries to remove excess heat
Febrile stage - the body temperature rises to a new set point established by the hypothalamus and remains there until there is a resolution to the cause of fever.

34. Rectal temperature are
120/80
16-20
about 1 degree higher than oral temperatures
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. Healthly adult
12-20
Evaporation
The emotions increase hormone secretion - and the body activities required for this increase heat production.
97.5 to 99.5

36. Irregular pulse - a period of normal rhythm broken by periods of irregularity or skipped beats.
bradycardia
crackles
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.
arrhythmia

37. While measuring the BP certain sounds may be heard that relate to the effect of the blood pressure cuff on the arterial wall.
Respiration
Korotkoff sounds
Cheyenne-Stokes
lysis

38. Air movemtn causes heat to be transferred from the skin to the air molecules.
Feeble
Tachypnea
Convection
Temporal

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

40. Bend of elbow
Pulse pressure
Brachial
Temporal
Korotkoff sounds Phase V: Silence

41. Normal body temperature ranges?
It increases to push the blood through more rigid pathways.
pyrexia
Hyperthermia related to infection or excessive heat exposure
97.5 to 99.5

42. How is pulse best found?
wheeze
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
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.

43. Korotkoff sounds Phase I: Tapping
Sinoatrial node (SA NODE)
low BP
Biot's respirations
systolic pressure indicated by faint - clear sound that gradually grow louder.

44. A normal - relaxed breathing pattern
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
absent
remittent
Eupnea

45. Shallow for two or three breaths with a period of variable apnea. occur in patients with increased intracranial pressure.

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46. Murmur or swishing sounds that increase as the cuff is deflated
Korotkoff sounds Phase II Swishing
Tachypnea
Radial
Respiration

47. Groin area
constant
Pulse
The emotions increase hormone secretion - and the body activities required for this increase heat production.
Femoral

48. The volume of blood pushed into the aorta per heartbeat.
Pulse
Femoral
Stroke volume
Axillary.

49. High oxygen
Systolic pressure
absent
hyperoxia
120-139/80-89

50. Barely palpable
fever
left Sims position
Irregular
Feeble