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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. How should baby's temperature be taken?
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
Cardiac Output
20-30
Axillary.

2. Weak and may be irregular
Biot's respirations
thready
Irregular
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

3. Normal body temperature ranges?
from drug therapy - a neurologic problem or dehydration.
Respiration
97.5 to 99.5
The emotions increase hormone secretion - and the body activities required for this increase heat production.

4. The temperature is continuously elevated with less than 1 degree of variation within a 24-hour period.
dyspnea
constant
absent
+3

5. Stage 2 hypertension
lysis
^160/^100
the lungs
hypertension

6. Louder knocking sound that occurs wit each heartbeat
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.
Korotkoff sounds Phase III: Knocking
120-139/80-89
Biot's respirations

7. Stage 1 hypertension
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
140-159/90-99
hypoxia

8. Stress & emotions. BP?
Axillary.
in the alveoli - tiny thin-walled sacs
higher
Tall - slender people mayy ave a slower pulse rate than short - stout persons

9. How do drugs affect pulse?
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
120/80
120/70
Biot's respirations

10. High oxygen
left Sims position
hyperoxia
12-20
carotid

11. Drop in blood pressure when arising to a standing position.
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
orthostatic hypertension
Korotkoff sounds
120/80

12. The volume of blood pushed into the aorta per heartbeat.
Vascular resistance drops and the blood pressure decreases
Eupnea
+2
Stroke volume

13. What patients should not use a glass thermometer orally?
Tachypnea
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
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
uncooperative patient - children - combative patients - dementia

14. If blood becomes thicker - like when excessive blood cells are manufactured what happens to BP?
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
Radial
low BP

15. Pulse above 100 beats per minute
Irregular
men - African Americans - under a lot of stress - obese
tachycardia
Tachypnea

16. Are infants blood pressure low or high?
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
temperature - pulse - respiration - blood pressure - and pain level.
low
crackles

17. What are the 5 vital signs?
constant
Sinoatrial node (SA NODE)
Hyperthermia related to infection or excessive heat exposure
temperature - pulse - respiration - blood pressure - and pain level.

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

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19. Adolescent
72 bpm
in the alveoli - tiny thin-walled sacs
systolic pressure indicated by faint - clear sound that gradually grow louder.
16-20

20. When is apicial pulse used?
about 1 degree lower than oral temperatures
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.
apnea
60 to 70 mL

21. What happens whens vasoconstriction causes peripheral vascular resistance to rise?
oximetry
3 in the right lung and 2 lobes in the left
the blood pressure will rise in order to push the blood along.
males have higher bp - until menopause then they are the same

22. If the cardiac output falls what will happen to the BP?
It will also fall
thready
about 1 degree higher than oral temperatures
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.

23. The maximum pressure exerted on the artery during left ventricular contraction.
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
Sinoatrial node (SA NODE)
Systolic pressure
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.

24. Rectal temperature are
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Femoral
about 1 degree higher than oral temperatures
Vascular resistance drops and the blood pressure decreases

25. State of insufficient oxygen
hypoxemia
96.5 to 97.5
hypoxia
The pulse rate increases at the rate of 7-10 beats for each degree of temperature

26. Pulse lower than 60 beats per minute
bradycardia
Hyperventilation
Systolic pressure
Acute anxiety stimulate the nervous system - raising the pulse.

27. Axillary temperature are
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
about 1 degree lower than oral temperatures
palpate

28. Slow and shallow breathing - leads to hypoxemia.
Hyperthermia related to infection or excessive heat exposure
Respiration
pyrogens
bradypnea

29. While measuring the BP certain sounds may be heard that relate to the effect of the blood pressure cuff on the arterial wall.
low BP
Korotkoff sounds
higher
ausculatation

30. How does age affect pulse?
Diaphoresis
Stroke volume
The pulse rate gradually diminishes from birth to adulthood
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.

31. How is pulse best found?
fever
Korotkoff sounds Phase III: Knocking
about 1 degree higher than oral temperatures
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.

32. Diurnal variation BP?
Pulse pressure
The pulse rate gradually diminishes from birth to adulthood
lysis
blood pressure is lowest in the morning. and higher in the afternoone

33. Risk for prolonged hypertension
Sinoatrial node (SA NODE)
bradypnea
Korotkoff sounds
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes

34. When the vascular walls lose elasticity - as with arteriosclerosis and aging what happens to BP?
Temperature will remain below 102 degrees with use of hypothermia blanket
crackles
It increases to push the blood through more rigid pathways.
Stertor

35. Abrupt decline in fever
+3
Acute anxiety stimulate the nervous system - raising the pulse.
Crisis
men - African Americans - under a lot of stress - obese

36. Barely palpable
bradycardia
It increases to push the blood through more rigid pathways.
Feeble
men - African Americans - under a lot of stress - obese

37. Bend of elbow
Brachial
the rate - the rhythm - and volume
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
Biot's respirations

38. What characteristics should be noted when checking the pulse?
the rate - the rhythm - and 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.
72 bpm
+1

39. This affects the character of the pulse.
Stroke Volume
Systolic pressure
Radial
Convection

40. Heat is lost from the body by evaporation. resulting in a daily loss of 800mL of water from skin and lungs.
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.
Pulse pressure
Evaporation
60 to 70 mL

41. Elevated temperature
140-159/90-99
arrhythmia
It will also fall
fever

42. Those at risk for hypothermia include
Temporal
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.
Korotkoff sounds
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.

43. Substances tat cause fever
pyrogens
Nursing interventions to reduce fever
+3
Systolic pressure

44. 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.
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
Hypothermia
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 rate - the rhythm - and volume

45. How do emotions increase the pulse rate?
120/70
low BP
Pulse
Acute anxiety stimulate the nervous system - raising the pulse.

46. Air movemtn causes heat to be transferred from the skin to the air molecules.
Evaporation
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.
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.
Convection

47. 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
Acute anxiety stimulate the nervous system - raising the pulse.
Dorsalis pedis
Hyperventilation
the blood pressure will rise in order to push the blood along.

48. What happens when vasodilation occurs?
Vascular resistance drops and the blood pressure decreases
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.
Korotkoff sounds Phase IV: Muffling
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.

49. BP at or lower 90/60.
Stroke volume
hypotension
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
It will also fall

50. Strong and regular ( even beats wit moderate force)
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.
BMR
It increases to push the blood through more rigid pathways.
+2

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Measuring Vital Signs

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