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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. Groin area
shallow or slow breathing
Femoral
The pulse rate gradually diminishes from birth to adulthood
the blood pressure will rise in order to push the blood along.

2. Both strong and weak beats occur within 1 minute
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.
Irregular
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
higher

3. Top of left foot
Dorsalis pedis
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
Evaporation
Eupnea

4. People most at risk for hypertension
men - African Americans - under a lot of stress - obese
Vascular resistance drops and the blood pressure decreases
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.
Hyperventilation

5. What happens whens vasoconstriction causes peripheral vascular resistance to rise?
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.
the blood pressure will rise in order to push the blood along.
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
low

6. Louder knocking sound that occurs wit each heartbeat
arrhythmia
Korotkoff sounds Phase III: Knocking
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
males have higher bp - until menopause then they are the same

7. How does increased body temperature increase the pulse?
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
Nursing interventions to reduce fever
20-30
96.5 to 97.5

8. How does size affect pulse?
in the alveoli - tiny thin-walled sacs
Core Temperature
120/70
Tall - slender people mayy ave a slower pulse rate than short - stout persons

9. Absence of breathing
dyspnea
apnea
Systolic pressure
hypoxia

10. Rectal temperature are
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
pyrogens
about 1 degree higher than oral temperatures
Stimulants increase the pulse rate. Depressants decrease the pulse rate.

11. 3 yr old
Respiration
Tachypnea
20-30
96.5 to 97.5

12. Newborn
Acute anxiety stimulate the nervous system - raising the pulse.
120/70
30-80
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.

13. Korotkoff sounds Ausculatatory gap:
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
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.
Nursing interventions to reduce fever
Cardiac Output

14. How should baby's temperature be taken?
72 bpm
Axillary.
hypotension
tachycardia

15. Are infants blood pressure low or high?
Radial
low
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
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.

16. Sex BP?
males have higher bp - until menopause then they are the same
hyperoxia
Dorsalis pedis
shallow or slow breathing

17. The difference between the systolic pressure and the diastolic pressure
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
16-20
Pulse pressure
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.

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?
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
hypoxia
the rate - the rhythm - and volume
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.

19. Alternating rise and fall of the temperature.
Cheyenne-Stokes
intermittent
Kussmaul's respiration
in the alveoli - tiny thin-walled sacs

20. Abrupt decline in fever
30-80
Crisis
Brachial
lysis

21. Substances tat cause fever
20-30
pyrexia
pyrogens
tachycardia

22. Fever above 100.2 F
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
pyrexia
apnea

23. Head injury 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
left Sims position
Evaporation
raises BP.

24. Shock - hemorrhage - low cardiac output - inadequate volume of blood?
pyrogens
uncooperative patient - children - combative patients - dementia
low BP
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.

25. Low oxygen
Dorsalis pedis
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
in the alveoli - tiny thin-walled sacs
hypoxia

26. How do drugs affect pulse?
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
the lungs
Evaporation
^160/^100

27. Heart
men - African Americans - under a lot of stress - obese
16-20
Apical
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.

28. How is pulse best found?
orthostatic hypertension
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.
20-30
BMR

29. Whats the best position to take a rectal temperature?
left Sims position
BMR
tachycardia
Crisis

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

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31. Weak and regular (even beats wit poor force)
+1
pyrexia
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
Nursing interventions to reduce fever

32. Excessive sweat production
Diaphoresis
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
120-139/80-89
hyperoxia

33. right arm vs. left arm/ arm vs. leg BP?
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
bradycardia
absent

34. 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
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
Core Temperature
60 to 70 mL

35. Gas exchange in the blood occurs where?
Temporal
96.5 to 97.5
in the alveoli - tiny thin-walled sacs
men - African Americans - under a lot of stress - obese

36. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
apnea
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.
Rhonchi
Stroke Volume

37. The lower pressure exerted on the artery when the heart is at rest inbetween contractions.
Diastolic pressure
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
absent
The emotions increase hormone secretion - and the body activities required for this increase heat production.

38. Those at risk for hypothermia include
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.
hyperoxia
apnea
pyrexia

39. Murmur or swishing sounds that increase as the cuff is deflated
oximeter
Hypothermia
hypertension
Korotkoff sounds Phase II Swishing

40. Weak and may be irregular
Respiration
ausculatation
thready
Crisis

41. No pulse palpable or heard on ausculation
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
120/70
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.

42. Barely palpable
Feeble
left Sims position
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
Femoral

43. How do you measure the apical pulse?
Tall - slender people mayy ave a slower pulse rate than short - stout persons
absent
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
Acute anxiety stimulate the nervous system - raising the pulse.

44. While measuring the BP certain sounds may be heard that relate to the effect of the blood pressure cuff on the arterial wall.
Korotkoff sounds
cardiac patients or patients who have had rectal surgery.
from drug therapy - a neurologic problem or dehydration.
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.

45. Enviromental temperature BP?
males have higher bp - until menopause then they are the same
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
Relapsing
Korotkoff sounds Phase II Swishing

46. Risk for prolonged hypertension
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.
120/70
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.

47. The average temperature in the older adult
crackles
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
96.5 to 97.5
hypertension

48. How is shock caused?
the blood pressure will rise in order to push the blood along.
Femoral
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
hypoxia

49. A normal - relaxed breathing pattern
Hyperventilation
Eupnea
120/70
+2

50. Breathing is an involuntary automatic function controlled by the respiratory center located where?
Pons and Medulla of the brainstem
Stroke volume
lysis
97.5 to 99.5

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Measuring Vital Signs

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