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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. 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.
hypoxemia
Radial
Stroke volume
temperature - pulse - respiration - blood pressure - and pain level.

2. Korotkoff sounds Ausculatatory gap:
Korotkoff sounds Phase IV: Muffling
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
raises BP.
Pedal pulse

3. Side of neck
Pedal pulse
orthostatic hypertension
Nursing interventions to reduce fever
carotid

4. Average blood pressure should be
120/70
low
Cardiac Output
The pulse rate increases at the rate of 7-10 beats for each degree of temperature

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

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6. Inside ankle
uncooperative patient - children - combative patients - dementia
Posterior tibial
120/70
Cardiac Output

7. Taking axillary temperature
fever
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
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.
Femoral

8. If the cardiac output falls what will happen to the BP?
Pulse
It will also fall
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
^160/^100

9. When should rectal temperatures NOT be used?
16-20
cardiac patients or patients who have had rectal surgery.
dyspnea
Systolic pressure

10. Heat is lost from the body by evaporation. resulting in a daily loss of 800mL of water from skin and lungs.
oximeter
the rate - the rhythm - and volume
120/70
Evaporation

11. 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
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
Nursing interventions to reduce fever
Korotkoff sounds Phase IV: Muffling
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

12. Full and bounding (even beats wit strong force)
16-20
wheeze
the rate - the rhythm - and volume
+3

13. Weak and may be irregular
thready
bradycardia
shallow or slow breathing
Systolic pressure

14. 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?
Rhonchi
Apical
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
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

15. Weak and regular (even beats wit poor force)
+1
Rhonchi
absent
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes

16. Those at risk for hypothermia include
the blood pressure will rise in order to push the blood along.
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.
temperature - pulse - respiration - blood pressure - and pain level.
hypoxia

17. How does increased body temperature increase the pulse?
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
Tachypnea
Evaporation
pyrogens

18. Fever above 100.2 F
pyrexia
Pulse
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
Evaporation

19. 2nd stage of fever is?
constant
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
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.
from drug therapy - a neurologic problem or dehydration.

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

21. What pulse is checked to determine whether there is any blockage of circulation in the artery up to that point - especially in patients who have had cardiac catherization using the femoral artery for the insertion of the catheter or those who had sur
16-20
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
Pedal pulse

22. Difficult and labored breathing - can often be accompanied by flared nostrils - anxious appearance - and statements such as I cant get enough air.
Korotkoff sounds
Cardiac Output
dyspnea
Irregular

23. Elevated temperature
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
fever
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.
Pulse

24. Top of left foot
shallow or slow breathing
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
60 to 70 mL
Dorsalis pedis

25. How do drugs affect pulse?
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
about 1 degree higher than oral temperatures
12-20
thready

26. What are the 5 vital signs?
It increases to push the blood through more rigid pathways.
Increases as body tries to remove excess heat
from drug therapy - a neurologic problem or dehydration.
temperature - pulse - respiration - blood pressure - and pain level.

27. Symptoms of hypoxia
Convection
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.
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds

28. How does menstrual cycle and pregnancy raise the body's temperature?
men - African Americans - under a lot of stress - obese
the blood pressure will rise in order to push the blood along.
Korotkoff sounds Phase II Swishing
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.

29. 3 yr old
absent
hypoxemia
20-30
The pulse rate increases at the rate of 7-10 beats for each degree of temperature

30. 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
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.
males have higher bp - until menopause then they are the same
ausculatation

31. Normal body temperature ranges?
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
Kussmaul's respiration
97.5 to 99.5
pyrexia

32. What happens whens vasoconstriction causes peripheral vascular resistance to rise?
Sinoatrial node (SA NODE)
It will also fall
the blood pressure will rise in order to push the blood along.
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.

33. The temperature falls to normal and then rises again in a repeating pattern.
Pulse
The emotions increase hormone secretion - and the body activities required for this increase heat production.
Korotkoff sounds
Relapsing

34. Carbon dioxide is carried as bicarbonate ion in the blood until it reaches where?
men - African Americans - under a lot of stress - obese
the lungs
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
uncooperative patient - children - combative patients - dementia

35. How should baby's temperature be taken?
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
Axillary.
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
Diastolic pressure

36. What affects does aging do to the blood pressure?
60 to 70 mL
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
Eupnea
hypoxemia

37. Abrupt decline in fever
hyperoxia
Temporal
Rhonchi
Crisis

38. Excessive sweat production
Convection
Eupnea
Diaphoresis
shallow or slow breathing

39. respirations become faster and deeper - then slower and shallower wit a period of apnea - called the death rattle.
Cheyenne-Stokes
Increases as body tries to remove excess heat
Respiration
It will also fall

40. 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.
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
Stroke Volume
remittent

41. People most at risk for hypertension
men - African Americans - under a lot of stress - obese
wheeze
97.5 to 99.5
Hyperthermia related to infection or excessive heat exposure

42. How does age affect pulse?
The pulse rate gradually diminishes from birth to adulthood
hypertension
temperature - pulse - respiration - blood pressure - and pain level.
Pulse pressure

43. How is pulse best found?
hyperoxia
intermittent
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
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.

44. Does the respiration rate increase or decrease during fever?
Radial
left Sims position
Increases as body tries to remove excess heat
Apical

45. Sex BP?
males have higher bp - until menopause then they are the same
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
Biot's respirations
Posterior tibial

46. Heart
low
temperature - pulse - respiration - blood pressure - and pain level.
Apical
about 1 degree lower than oral temperatures

47. A normal - relaxed breathing pattern
higher
Eupnea
thready
The emotions increase hormone secretion - and the body activities required for this increase heat production.

48. Measurement of oxygen
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
oximetry
Temperature will remain below 102 degrees with use of hypothermia blanket
The emotions increase hormone secretion - and the body activities required for this increase heat production.

49. Bend of knee
Nursing interventions to reduce fever
popliteal
Stertor
bradycardia

50. 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
oximeter
Dorsalis pedis
arrhythmia

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Measuring Vital Signs

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