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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. Low oxygen
about 1 degree higher than oral temperatures
Nursing interventions to reduce fever
left Sims position
hypoxia

2. Strong and regular ( even beats wit moderate force)
+2
carotid
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
intermittent

3. How do you measure the apical pulse?
20-30
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 pulse rate increases at the rate of 7-10 beats for each degree of temperature
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.

4. What affects does aging do to the heart rate?

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5. Groin area
Pulse
oximetry
Sinoatrial node (SA NODE)
Femoral

6. Bend of elbow
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
^160/^100
Brachial
the rate - the rhythm - and volume

7. What should you do if you cannot determine BP by ausculation?
Conduction
the rate - the rhythm - and volume
3 in the right lung and 2 lobes in the left
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.

8. Hearing
Tachypnea
oximeter
Irregular
ausculatation

9. An example of a nursing diagnoses
ausculatation
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
Hyperthermia related to infection or excessive heat exposure
the rate - the rhythm - and volume

10. High oxygen
hyperoxia
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
Increases as body tries to remove excess heat
Hyperthermia related to infection or excessive heat exposure

11. What patients should not use a glass thermometer orally?
Pulse
in the alveoli - tiny thin-walled sacs
wheeze
uncooperative patient - children - combative patients - dementia

12. Does the respiration rate increase or decrease during fever?
intermittent
Increases as body tries to remove excess heat
Stertor
absent

13. If the cardiac output falls what will happen to the BP?
^160/^100
Sinoatrial node (SA NODE)
It will also fall
Axillary.

14. Full and bounding (even beats wit strong force)
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.
systolic pressure indicated by faint - clear sound that gradually grow louder.
+3
Radial

15. Risk for prolonged hypertension
120/80
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
Irregular
Nursing interventions to reduce fever

16. Gas exchange in the blood occurs where?
96.5 to 97.5
Pedal pulse
in the alveoli - tiny thin-walled sacs
12-20

17. What will happen in febrile stage if temperature is very high or temperature stays for a long amount of time?
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
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.
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
Stertor

18. How does size affect pulse?
Cheyenne-Stokes
shallow or slow breathing
+2
Tall - slender people mayy ave a slower pulse rate than short - stout persons

19. Carbon dioxide is carried as bicarbonate ion in the blood until it reaches where?
Sinoatrial node (SA NODE)
the lungs
96.5 to 97.5
Stertor

20. A normal - relaxed breathing pattern
low
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
Eupnea
Evaporation

21. Adolescent
120/80
16-20
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
Korotkoff sounds

22. By measuring the blood pressure you obtain vital info about what?
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.
60 to 70 mL
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
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

23. No pulse palpable or heard on ausculation
Nursing interventions to reduce fever
lysis
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.
absent

24. What characteristics should be noted when checking the pulse?
cardiac patients or patients who have had rectal surgery.
palpate
the rate - the rhythm - and volume
Conduction

25. Shallow for two or three breaths with a period of variable apnea. occur in patients with increased intracranial pressure.

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26. Fever above 100.2 F
pyrexia
ausculatation
thready
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.

27. Heat is lost from the body by evaporation. resulting in a daily loss of 800mL of water from skin and lungs.
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
the rate - the rhythm - and volume
Diastolic pressure
Evaporation

28. 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.
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.
oximeter
96.5 to 97.5
Tachypnea

29. Macine that measures oxygen in the blood by determining the percentage of hemoglobin that is bound with oxygen.
oximeter
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.
Femoral
men - African Americans - under a lot of stress - obese

30. Stage 2 hypertension
^160/^100
hypoxemia
Pons and Medulla of the brainstem
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.

31. A sudden change or muffling of the sound. (indicates diastolic pressure in children and some adults)
systolic pressure indicated by faint - clear sound that gradually grow louder.
Relapsing
bradycardia
Korotkoff sounds Phase IV: Muffling

32. When the vascular walls lose elasticity - as with arteriosclerosis and aging what happens to BP?
Korotkoff sounds Phase IV: Muffling
3 in the right lung and 2 lobes in the left
It increases to push the blood through more rigid pathways.
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

33. Gradual return to a normal temperature
Stroke volume
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
lysis
hypoxia

34. The temperature is continuously elevated with less than 1 degree of variation within a 24-hour period.
constant
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
Evaporation
lysis

35. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
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.
Rhonchi
oximetry
from drug therapy - a neurologic problem or dehydration.

36. Substances tat cause fever
pyrogens
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.
stridor
remittent

37. Measurement of oxygen
oximetry
30-80
ausculatation
Core Temperature

38. How should baby's temperature be taken?
Biot's
Irregular
Axillary.
16-20

39. How does age affect pulse?
from drug therapy - a neurologic problem or dehydration.
hypoxia
The pulse rate gradually diminishes from birth to adulthood
Blood pressure increases because there is more volume of blood in the vascular system.

40. The temperature falls to normal and then rises again in a repeating pattern.
Vascular resistance drops and the blood pressure decreases
Relapsing
Increases as body tries to remove excess heat
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.

41. Symptoms of hypoxia
30-80
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
men - African Americans - under a lot of stress - obese
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.

42. What affects does aging do to the blood pressure?
raises BP.
Relapsing
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 systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.

43. What are the 5 vital signs?
120/80
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
temperature - pulse - respiration - blood pressure - and pain level.
The emotions increase hormone secretion - and the body activities required for this increase heat production.

44. Absence of breathing
Biot's
Korotkoff sounds Phase IV: Muffling
Apical
apnea

45. Alternating rise and fall of the temperature.
intermittent
Diaphoresis
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.

46. Those at risk for hypothermia include
low 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
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.
Stertor

47. Whisting sound of air forced past a partial obstruction - as found in asthma or emphysema.
wheeze
16-20
Posterior tibial
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

48. Bend of knee
Posterior tibial
thready
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
popliteal

49. The rate at which heat is produced when the body is at rest.
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
BMR
hyperoxia
Stroke Volume

50. Head injury or any increased intracranial pressure will depress the respiratory center and result in?
higher
shallow or slow breathing
raises BP.
Irregular