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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. The pulse rate multiplied by the stroke volume. This is the amount of blood pumped by the left ventricle in 1 minute. Averaging at about 5mL per minute.
Cardiac Output
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
arrhythmia
Pons and Medulla of the brainstem

2. Full and bounding (even beats wit strong force)
+3
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
16-20
12-20

3. Subnormal body temperature the regulating center in the hypothalamus is greatly impaired when the temperature of the body falls below 94 degrees - at that point? sleepiness and coma are apt to develop.
Pulse pressure
low
Hypothermia
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.

4. Elderly respiration
16-20
remittent
72 bpm
120-139/80-89

5. Increased rate and depth with panting and long grunting exhalation. Often seen with patients with acidosis and renal failure.

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6. Korotkoff sounds Ausculatatory gap:
temperature - pulse - respiration - blood pressure - and pain level.
about 1 degree higher than oral temperatures
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
The pulse rate increases at the rate of 7-10 beats for each degree of temperature

7. Measurement of oxygen
Respiration
Hyperthermia related to infection or excessive heat exposure
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.
oximetry

8. Macine that measures oxygen in the blood by determining the percentage of hemoglobin that is bound with oxygen.
Stertor
left Sims position
Hyperventilation
oximeter

9. When warm skin touches a cool object - heat is lost to the object.
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.
hypoxia
Conduction
Tachypnea

10. When should rectal temperatures NOT be used?
cardiac patients or patients who have had rectal surgery.
30-80
the rate - the rhythm - and volume
97.5 to 99.5

11. Irregular pulse - a period of normal rhythm broken by periods of irregularity or skipped beats.
Dorsalis pedis
arrhythmia
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
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.

12. Diurnal variation BP?
ausculatation
Acute anxiety stimulate the nervous system - raising the pulse.
The pulse rate gradually diminishes from birth to adulthood
blood pressure is lowest in the morning. and higher in the afternoone

13. Inside ankle
Pons and Medulla of the brainstem
Pedal pulse
palpate
Posterior tibial

14. By measuring the blood pressure you obtain vital info about what?
Apical
The pulse rate gradually diminishes from birth to adulthood
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
Kussmaul's respiration

15. The maximum pressure exerted on the artery during left ventricular contraction.
Systolic pressure
pyrogens
Vascular resistance drops and the blood pressure decreases
raises BP.

16. Are infants blood pressure low or high?
Feeble
dyspnea
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
low

17. High oxygen
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.
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.
hyperoxia
bradycardia

18. 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?
Crisis
Stroke Volume
72 bpm
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.

19. The volume of blood pushed into the aorta per heartbeat.
Korotkoff sounds Phase II Swishing
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
bradycardia
Stroke volume

20. 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
tachycardia
Hyperventilation
palpate
96.5 to 97.5

21. Gas exchange in the blood occurs where?
in the alveoli - tiny thin-walled sacs
Irregular
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.
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds

22. Taking axillary temperature
low BP
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.
shallow or slow breathing
96.5 to 97.5

23. 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.
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.
16-20
remittent
from drug therapy - a neurologic problem or dehydration.

24. What will happen in febrile stage if temperature is very high or temperature stays for a long amount of time?
Kussmaul's respiration
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.
lysis
20-30

25. When should rectal temperatures be used?
fever
dyspnea
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
Acute anxiety stimulate the nervous system - raising the pulse.

26. People most at risk for hypertension
men - African Americans - under a lot of stress - obese
120/80
popliteal
Nursing interventions to reduce fever

27. An example of a nursing diagnoses
Femoral
Hyperthermia related to infection or excessive heat exposure
The emotions increase hormone secretion - and the body activities required for this increase heat production.
Apical

28. What affects does aging do to the respiratory rate?
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.
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
thready
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.

29. Weak and regular (even beats wit poor force)
the rate - the rhythm - and volume
+1
uncooperative patient - children - combative patients - dementia
bradypnea

30. Groin area
Femoral
140-159/90-99
+3
Korotkoff sounds Phase III: Knocking

31. Carbon dioxide is carried as bicarbonate ion in the blood until it reaches where?
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
The emotions increase hormone secretion - and the body activities required for this increase heat production.
the lungs
fever

32. What are the 5 vital signs?
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
temperature - pulse - respiration - blood pressure - and pain level.
16-20
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients

33. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
bradycardia
Diastolic pressure
Rhonchi
fever

34. Low oxygen
Korotkoff sounds Phase IV: Muffling
hypoxia
cardiac patients or patients who have had rectal surgery.
+3

35. 3 yr old
men - African Americans - under a lot of stress - obese
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
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
20-30

36. Hearing
hypoxia
pyrogens
ausculatation
carotid

37. Murmur or swishing sounds that increase as the cuff is deflated
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
Korotkoff sounds Phase II Swishing
120/70
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.

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

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39. Snoring sound produced when patients are unable to cough up secretions from the trachea or bronchi
Stertor
hypotension
+1
96.5 to 97.5

40. What happens to the blood if overhydration occurs?
carotid
Blood pressure increases because there is more volume of blood in the vascular system.
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.
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.

41. If the cardiac output falls what will happen to the BP?
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
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
It will also fall

42. How does increased body temperature increase the pulse?
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
Stroke Volume
16-20
males have higher bp - until menopause then they are the same

43. 1st stage of fever is?
Korotkoff sounds Phase II Swishing
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
12-20
bradypnea

44. Enviromental temperature BP?
It will also fall
remittent
raises BP.
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.

45. What characteristics should be noted when checking the pulse?
BMR
lysis
carotid
the rate - the rhythm - and volume

46. State of insufficient oxygen
thready
97.5 to 99.5
hypoxia
72 bpm

47. While measuring the BP certain sounds may be heard that relate to the effect of the blood pressure cuff on the arterial wall.
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
Korotkoff sounds

48. Bend of elbow
from drug therapy - a neurologic problem or dehydration.
about 1 degree lower than oral temperatures
Blood pressure increases because there is more volume of blood in the vascular system.
Brachial

49. Axillary temperature are
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
the rate - the rhythm - and volume
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
about 1 degree lower than oral temperatures

50. Alternating rise and fall of the temperature.
hyperoxia
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
Core Temperature
intermittent

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Measuring Vital Signs

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