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Measuring Vital Signs

Subjects : health-sciences, emergency-medicine

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. The rate at which heat is produced when the body is at rest.
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
about 1 degree lower than oral temperatures
lysis
BMR

2. Inside ankle
Irregular
Apical
Posterior tibial
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.

3. Stage 2 hypertension
Brachial
Axillary.
140-159/90-99
^160/^100

4. An example of nursing planning
Temperature will remain below 102 degrees with use of hypothermia blanket
pyrexia
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
hypoxia

5. Hearing
Biot's
72 bpm
ausculatation
97.5 to 99.5

6. 3rd stage of fever?
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
3 in the right lung and 2 lobes in the left
Posterior tibial
the rate - the rhythm - and volume

7. Full and bounding (even beats wit strong force)
+3
raises BP.
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
orthostatic hypertension

8. Measurement of oxygen
oximetry
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.
about 1 degree higher than oral temperatures
tachycardia

9. Are infants blood pressure low or high?
low
uncooperative patient - children - combative patients - dementia
Pulse pressure
the blood pressure will rise in order to push the blood along.

10. Shock - hemorrhage - low cardiac output - inadequate volume of blood?
120-139/80-89
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
Blood pressure increases because there is more volume of blood in the vascular system.
low BP

11. How do drugs affect pulse?
Posterior tibial
the rate - the rhythm - and volume
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
the lungs

12. When should rectal temperatures be used?
uncooperative patient - children - combative patients - dementia
Cardiac Output
Hyperventilation
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

13. Increased or rapid breathing results from te presence of fever and a number or diseases. breathing rate increased about 4 breaths for each degree increase in temperature.
from drug therapy - a neurologic problem or dehydration.
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
Tachypnea
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.

14. No pulse palpable or heard on ausculation
Nursing interventions to reduce fever
absent
Stroke volume
hypoxia

15. What characteristics should be noted when checking the pulse?
the rate - the rhythm - and volume
dyspnea
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.
Irregular

16. High oxygen
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
140-159/90-99
hyperoxia
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.

17. When should rectal temperatures NOT be used?
Pulse pressure
cardiac patients or patients who have had rectal surgery.
Dorsalis pedis
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.

18. If blood becomes thicker - like when excessive blood cells are manufactured what happens to BP?
It increases to push the blood through more rigid pathways.
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
hyperoxia
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.

19. Barely palpable
Feeble
Radial
Pulse
Apical

20. Elderly respiration
blood pressure is lowest in the morning. and higher in the afternoone
pyrogens
16-20
shallow or slow breathing

21. The temperature is continuously elevated with less than 1 degree of variation within a 24-hour period.
constant
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
It increases to push the blood through more rigid pathways.
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

22. Carbon dioxide is carried as bicarbonate ion in the blood until it reaches where?
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
the lungs
Increases as body tries to remove excess heat
Korotkoff sounds Phase II Swishing

23. The volume of blood pushed into the aorta per heartbeat.
Stroke volume
bradycardia
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Sinoatrial node (SA NODE)

24. respirations become faster and deeper - then slower and shallower wit a period of apnea - called the death rattle.
stridor
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.
Hyperventilation
Cheyenne-Stokes

25. Taking a rectal temperature
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
Stertor
Eupnea
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

26. Absence of breathing
140-159/90-99
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
apnea
hypoxia

27. While measuring the BP certain sounds may be heard that relate to the effect of the blood pressure cuff on the arterial wall.
Biot's
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
Korotkoff sounds
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.

28. 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
Pedal pulse
blood pressure is lowest in the morning. and higher in the afternoone
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Irregular

29. A sudden change or muffling of the sound. (indicates diastolic pressure in children and some adults)
16-20
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
wheeze
Korotkoff sounds Phase IV: Muffling

30. How should respirations be counted?
16-20
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
Pulse
bradycardia

31. What happens when vasodilation occurs?
Acute anxiety stimulate the nervous system - raising the pulse.
96.5 to 97.5
Vascular resistance drops and the blood pressure decreases
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

32. Whats the best position to take a rectal temperature?
males have higher bp - until menopause then they are the same
The pulse rate gradually diminishes from birth to adulthood
hypoxia
left Sims position

33. Bend of knee
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
^160/^100
popliteal
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

34. Heat is lost from the body by evaporation. resulting in a daily loss of 800mL of water from skin and lungs.
Korotkoff sounds Phase II Swishing
Evaporation
Apical
Temperature will remain below 102 degrees with use of hypothermia blanket

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

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36. When warm skin touches a cool object - heat is lost to the object.
Conduction
popliteal
hypotension
Blood pressure increases because there is more volume of blood in the vascular system.

37. 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.
Temperature will remain below 102 degrees with use of hypothermia blanket
Rhonchi
left Sims position

38. Side of neck
Hyperventilation
carotid
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
^160/^100

39. How should baby's temperature be taken?
dyspnea
palpate
Axillary.
in the alveoli - tiny thin-walled sacs

40. Korotkoff sounds Phase I: Tapping
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
systolic pressure indicated by faint - clear sound that gradually grow louder.
Apical

41. Bend of elbow
Diastolic pressure
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.
pyrexia
Brachial

42. This affects the character of the pulse.
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
Nursing interventions to reduce fever
Stroke Volume
carotid

43. What should you do if you cannot determine BP by ausculation?
+2
Posterior tibial
Evaporation
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.

44. How does increased body temperature increase the pulse?
16-20
intermittent
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
cardiac patients or patients who have had rectal surgery.

45. 2nd stage of fever is?
3 in the right lung and 2 lobes in the left
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.
arrhythmia
Biot's

46. How is pulse best found?
blood pressure is lowest in the morning. and higher in the afternoone
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 III: Knocking
Conduction

47. Groin area
Femoral
remittent
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 deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.

48. 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.
Systolic pressure
Hypothermia
shallow or slow breathing
+1

49. State of insufficient oxygen
arrhythmia
carotid
hypoxia
30-80

50. 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.
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.
+2
hypoxemia
hypoxia