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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. People most at risk for hypertension
3 in the right lung and 2 lobes in the left
men - African Americans - under a lot of stress - obese
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
hypoxia

2. Side of forehead
oximeter
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
about 1 degree lower than oral temperatures
Temporal

3. Hearing
Axillary.
Nursing interventions to reduce fever
Biot's respirations
ausculatation

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

5. How cardiac contractions are normally initiated by the electrical impules emerging from what?
about 1 degree higher than oral temperatures
Pulse pressure
Sinoatrial node (SA NODE)
wheeze

6. Both strong and weak beats occur within 1 minute
Convection
Irregular
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
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.

7. How does emotional stress raise the body's temperature?
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.
orthostatic hypertension
Kussmaul's respiration
The emotions increase hormone secretion - and the body activities required for this increase heat production.

8. Murmur or swishing sounds that increase as the cuff is deflated
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
Korotkoff sounds Phase II Swishing
It increases to push the blood through more rigid pathways.
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.

9. 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?
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.
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
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
Core Temperature

10. right arm vs. left arm/ arm vs. leg BP?
dyspnea
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
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
96.5 to 97.5

11. When is apicial pulse used?
constant
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.
Pulse
20-30

12. Adolescent
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
16-20
cardiac patients or patients who have had rectal surgery.
Systolic pressure

13. Whats the best position to take a rectal temperature?
left Sims position
12-20
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
Pulse

14. Obtaining the correct size for a cuff for BP?
120/80
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
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.

15. Elevated temperature
Hyperventilation
fever
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.
constant

16. The rate at which heat is produced when the body is at rest.
BMR
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
Tachypnea
constant

17. Does the respiration rate increase or decrease during fever?
Increases as body tries to remove excess heat
Pons and Medulla of the brainstem
pyrexia
bradycardia

18. The temperature falls to normal and then rises again in a repeating pattern.
Blood pressure increases because there is more volume of blood in the vascular system.
Relapsing
Stroke volume
orthostatic hypertension

19. 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.
stridor
low
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
Tachypnea

20. The exchange of oxygen and carbon dioxide in the lungs and tissues and is initiated by the act of breathing.
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
systolic pressure indicated by faint - clear sound that gradually grow louder.
Respiration
about 1 degree lower than oral temperatures

21. Groin area
Rhonchi
remittent
96.5 to 97.5
Femoral

22. Lobes in the lungs?
Feeble
3 in the right lung and 2 lobes in the left
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
Convection

23. How does menstrual cycle and pregnancy raise the body's temperature?
carotid
uncooperative patient - children - combative patients - dementia
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
+3

24. Fever above 100.2 F
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
pyrexia
absent
lysis

25. Prehypertension
120-139/80-89
16-20
Conduction
It increases to push the blood through more rigid pathways.

26. How do emotions increase the pulse rate?
Brachial
Acute anxiety stimulate the nervous system - raising the pulse.
Rhonchi
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.

27. The pressure wave causing te arterial walls in the vascular system each time the heart contracts to force blood into an already full aorta.
Diastolic pressure
systolic pressure indicated by faint - clear sound that gradually grow louder.
Biot's respirations
Pulse

28. What will happen in febrile stage if temperature is very high or temperature stays for a long amount of time?
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.
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.

29. The average temperature in the older adult
popliteal
96.5 to 97.5
Dorsalis pedis
oximeter

30. How does physical exercise 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.
97.5 to 99.5
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.
^160/^100

31. Newborn
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.
Temporal
30-80
ausculatation

32. What happens when vasodilation occurs?
Rhonchi
Vascular resistance drops and the blood pressure decreases
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
absent

33. When warm skin touches a cool object - heat is lost to the object.
cardiac patients or patients who have had rectal surgery.
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
Conduction
Tall - slender people mayy ave a slower pulse rate than short - stout persons

34. How does size affect pulse?
Tall - slender people mayy ave a slower pulse rate than short - stout persons
120/80
Increases as body tries to remove excess heat
Pedal pulse

35. What affects does aging do to the blood pressure?
140-159/90-99
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.
The emotions increase hormone secretion - and the body activities required for this increase heat production.
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.

36. No pulse palpable or heard on ausculation
It will also fall
Biot's
16-20
absent

37. Snoring sound produced when patients are unable to cough up secretions from the trachea or bronchi
Brachial
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
Stertor
Pulse pressure

38. 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
20-30
Nursing interventions to reduce fever
Cheyenne-Stokes
about 1 degree higher than oral temperatures

39. Taking axillary temperature
absent
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 BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
Nursing interventions to reduce fever

40. What characteristics should be noted when checking the pulse?
the blood pressure will rise in order to push the blood along.
Axillary.
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
the rate - the rhythm - and volume

41. The temperature is continuously elevated with less than 1 degree of variation within a 24-hour period.
constant
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
Biot's respirations

42. What are the 5 vital signs?
Pons and Medulla of the brainstem
temperature - pulse - respiration - blood pressure - and pain level.
Stroke volume
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.

43. Excessive sweat production
Femoral
+2
Diaphoresis
Pons and Medulla of the brainstem

44. Alternating rise and fall of the temperature.
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
Tall - slender people mayy ave a slower pulse rate than short - stout persons
intermittent
apnea

45. The volume of blood pushed into the aorta per heartbeat.
Stroke volume
tachycardia
palpate
^160/^100

46. How is shock caused?
from drug therapy - a neurologic problem or dehydration.
Korotkoff sounds Phase III: Knocking
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Diaphoresis

47. What happens to the blood if overhydration occurs?
constant
hypoxia
Blood pressure increases because there is more volume of blood in the vascular system.
systolic pressure indicated by faint - clear sound that gradually grow louder.

48. When the vascular walls lose elasticity - as with arteriosclerosis and aging what happens to BP?
hypoxia
+1
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.
It increases to push the blood through more rigid pathways.

49. Inside ankle
from drug therapy - a neurologic problem or dehydration.
Posterior tibial
Core Temperature
Cardiac Output

50. BP at or lower 90/60.
hypertension
hypotension
lysis
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