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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. How does emotional stress raise the body's temperature?
The emotions increase hormone secretion - and the body activities required for this increase heat production.
Pulse
palpate
hypoxia

2. An example of a nursing diagnoses
Hyperthermia related to infection or excessive heat exposure
120/80
in the alveoli - tiny thin-walled sacs
Evaporation

3. A sudden change or muffling of the sound. (indicates diastolic pressure in children and some adults)
Crisis
120-139/80-89
systolic pressure indicated by faint - clear sound that gradually grow louder.
Korotkoff sounds Phase IV: Muffling

4. The rate at which heat is produced when the body is at rest.
Pulse
120/80
BMR
left Sims position

5. 3rd stage of fever?
20-30
bradycardia
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
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.

6. Substances tat cause fever
16-20
Korotkoff sounds Phase V: Silence
pyrogens
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

7. Bend of knee
popliteal
orthostatic hypertension
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.
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.

8. 3 yr old
Temperature will remain below 102 degrees with use of hypothermia blanket
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.
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.
20-30

9. respirations become faster and deeper - then slower and shallower wit a period of apnea - called the death rattle.
Cheyenne-Stokes
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
+1
Conduction

10. An example of nursing planning
12-20
Temperature will remain below 102 degrees with use of hypothermia blanket
tachycardia
fever

11. Slow and shallow breathing - leads to hypoxemia.
remittent
bradypnea
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
It will also fall

12. Disappearance of sound. (marks diastolic pressure in adults)
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.
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.
Korotkoff sounds Phase V: Silence
Stimulants increase the pulse rate. Depressants decrease the pulse rate.

13. Stress & emotions. BP?
^160/^100
remittent
higher
72 bpm

14. Irregular pulse - a period of normal rhythm broken by periods of irregularity or skipped beats.
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.
arrhythmia
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.

15. 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.
+1
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
hypoxemia
+3

16. Prehypertension
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
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
120-139/80-89
16-20

17. How does age affect pulse?
The pulse rate gradually diminishes from birth to adulthood
Temporal
72 bpm
oximetry

18. Abrupt decline in fever
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
Crisis
Kussmaul's respiration
Pedal pulse

19. What affects does aging do to the respiratory rate?
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
hypoxia
Sinoatrial node (SA NODE)
the rate - the rhythm - and volume

20. Top of left foot
Hyperthermia related to infection or excessive heat exposure
Dorsalis pedis
Temperature will remain below 102 degrees with use of hypothermia blanket
from drug therapy - a neurologic problem or dehydration.

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

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22. This affects the character of the pulse.
Korotkoff sounds
Biot's
Stroke Volume
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.

23. Shock - hemorrhage - low cardiac output - inadequate volume of blood?
Diastolic pressure
Stertor
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
low BP

24. Gas exchange in the blood occurs where?
in the alveoli - tiny thin-walled sacs
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
120/80
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.

25. What affects does aging do to the blood pressure?
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
bradycardia
the blood pressure will rise in order to push the blood along.
blood pressure is lowest in the morning. and higher in the afternoone

26. Signs and symptoms of shock
Evaporation
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
120/80
from drug therapy - a neurologic problem or dehydration.

27. How should respirations be counted?
temperature - pulse - respiration - blood pressure - and pain level.
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
^160/^100
Eupnea

28. Stage 1 hypertension
carotid
the lungs
140-159/90-99
^160/^100

29. When should rectal temperatures be used?
Evaporation
Biot's
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
Systolic pressure

30. Feel
96.5 to 97.5
palpate
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
popliteal

31. The volume of blood pushed into the aorta per heartbeat.
Stroke volume
hypoxemia
tachycardia
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.

32. 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
120-139/80-89
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.
intermittent
Nursing interventions to reduce fever

33. 2nd stage of fever is?
Kussmaul's respiration
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
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. 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
bradypnea
the blood pressure will rise in order to push the blood along.
low BP
Hyperventilation

35. How do emotions increase the pulse rate?
Kussmaul's respiration
Acute anxiety stimulate the nervous system - raising the pulse.
Hyperthermia related to infection or excessive heat exposure
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds

36. What should you do if you cannot determine BP by ausculation?
men - African Americans - under a lot of stress - obese
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
uncooperative patient - children - combative patients - dementia
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.

37. Risk for prolonged hypertension
Radial
blood pressure is lowest in the morning. and higher in the afternoone
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
It will also fall

38. Korotkoff sounds Phase I: Tapping
140-159/90-99
thready
systolic pressure indicated by faint - clear sound that gradually grow louder.
pyrexia

39. Rectal temperature are
about 1 degree higher than oral temperatures
hypertension
hypoxemia
Hyperventilation

40. When is apicial pulse used?
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.
about 1 degree higher than oral temperatures
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
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.

41. Inside ankle
orthostatic hypertension
Posterior tibial
Biot's
20-30

42. A high temperature falls - usually in the morning - and again rises later in the day. The temperature never fails to normal in this type of fever until recovery occurs.
Hyperventilation
16-20
Tall - slender people mayy ave a slower pulse rate than short - stout persons
remittent

43. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
Rhonchi
carotid

44. How does menstrual cycle and pregnancy 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.
Hyperventilation
Apical
Cardiac Output

45. When the heart contracts How many mLs of blood is propelled into the aorta?
Cardiac Output
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
Pedal pulse
60 to 70 mL

46. Air movemtn causes heat to be transferred from the skin to the air molecules.
Diaphoresis
Convection
ausculatation
16-20

47. When warm skin touches a cool object - heat is lost to the object.
systolic pressure indicated by faint - clear sound that gradually grow louder.
Conduction
Irregular
It will also fall

48. Both strong and weak beats occur within 1 minute
uncooperative patient - children - combative patients - dementia
hypertension
fever
Irregular

49. Absence of breathing
apnea
+2
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.
Pedal pulse

50. Crowing sound on inspiration caused by obstruction of the upper air passages - as occurs in croup or laryngitis
stridor
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.
Eupnea
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds