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Test your basic knowledge |
Measuring Vital Signs
Start Test
Study First
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. 2nd stage of fever is?
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
Stertor
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.
2. How does size affect pulse?
Kussmaul's respiration
lysis
Korotkoff sounds Phase IV: Muffling
Tall - slender people mayy ave a slower pulse rate than short - stout persons
3. Alternating rise and fall of the temperature.
intermittent
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
hypotension
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
4. Gas exchange in the blood occurs where?
Conduction
in the alveoli - tiny thin-walled sacs
crackles
+2
5. Diurnal variation BP?
120-139/80-89
Cheyenne-Stokes
lysis
blood pressure is lowest in the morning. and higher in the afternoone
6. Why would patients experience orthostatic hypotenstion?
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.
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
Respiration
from drug therapy - a neurologic problem or dehydration.
7. What patients should not use a glass thermometer orally?
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
blood pressure is lowest in the morning. and higher in the afternoone
uncooperative patient - children - combative patients - dementia
Vascular resistance drops and the blood pressure decreases
8. Pulse above 100 beats per minute
Feeble
Apical
tachycardia
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
9. Stage 2 hypertension
^160/^100
intermittent
crackles
lysis
10. State of insufficient oxygen
hypoxia
Vascular resistance drops and the blood pressure decreases
lysis
absent
11. Bend of knee
popliteal
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.
constant
blood pressure is lowest in the morning. and higher in the afternoone
12. Difficult and labored breathing - can often be accompanied by flared nostrils - anxious appearance - and statements such as I cant get enough air.
dyspnea
about 1 degree higher than oral temperatures
the blood pressure will rise in order to push the blood along.
Hypothermia
13. When the heart contracts How many mLs of blood is propelled into the aorta?
fever
Pulse pressure
Korotkoff sounds Phase V: Silence
60 to 70 mL
14. What should you do if you cannot determine BP by ausculation?
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.
cardiac patients or patients who have had rectal surgery.
about 1 degree lower than oral temperatures
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
15. What happens when vasodilation occurs?
Vascular resistance drops and the blood pressure decreases
Tall - slender people mayy ave a slower pulse rate than short - stout persons
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
16. Newborn
hypoxia
30-80
men - African Americans - under a lot of stress - obese
in the alveoli - tiny thin-walled sacs
17. Enviromental temperature BP?
120-139/80-89
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
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.
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
18. What characteristics should be noted when checking the pulse?
Stroke volume
the rate - the rhythm - and volume
pyrexia
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
19. What are the 5 vital signs?
16-20
temperature - pulse - respiration - blood pressure - and pain level.
Diaphoresis
Nursing interventions to reduce fever
20. If blood becomes thicker - like when excessive blood cells are manufactured what happens to BP?
Increases as body tries to remove excess heat
Sinoatrial node (SA NODE)
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
the rate - the rhythm - and volume
21. 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.
72 bpm
20-30
Femoral
remittent
22. Disappearance of sound. (marks diastolic pressure in adults)
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.
Korotkoff sounds Phase V: Silence
Conduction
Pons and Medulla of the brainstem
23. Korotkoff sounds Ausculatatory gap:
Hypothermia
bradypnea
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
Blood pressure increases because there is more volume of blood in the vascular system.
24. Symptoms of hypoxia
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
96.5 to 97.5
the blood pressure will rise in order to push the blood along.
cardiac patients or patients who have had rectal surgery.
25. Whisting sound of air forced past a partial obstruction - as found in asthma or emphysema.
Evaporation
Tachypnea
120-139/80-89
wheeze
26. Side of forehead
Increases as body tries to remove excess heat
palpate
Temporal
Biot's
27. Side of wrist
low
Radial
tachycardia
+1
28. How should respirations be counted?
Brachial
oximetry
about 1 degree higher than oral temperatures
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
29. Those at risk for hypothermia include
orthostatic hypertension
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
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.
30. If the cardiac output falls what will happen to the BP?
Hyperventilation
Irregular
It will also fall
Relapsing
31. When should rectal temperatures be used?
Blood pressure increases because there is more volume of blood in the vascular system.
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
120/70
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
32. Crowing sound on inspiration caused by obstruction of the upper air passages - as occurs in croup or laryngitis
Respiration
pyrexia
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
stridor
33. Fast - deep respirations with abrupt pauses
34. Shallow for two or three breaths with a period of variable apnea. occur in patients with increased intracranial pressure.
35. A sudden change or muffling of the sound. (indicates diastolic pressure in children and some adults)
Stertor
120-139/80-89
Biot's respirations
Korotkoff sounds Phase IV: Muffling
36. This affects the character of the pulse.
Diastolic pressure
16-20
wheeze
Stroke Volume
37. Signs and symptoms of shock
left Sims position
Respiration
tachycardia
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
38. 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?
Rhonchi
hypotension
hypertension
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
39. Taking axillary temperature
3 in the right lung and 2 lobes in the left
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.
cardiac patients or patients who have had rectal surgery.
96.5 to 97.5
40. Irregular pulse - a period of normal rhythm broken by periods of irregularity or skipped beats.
Kussmaul's respiration
12-20
arrhythmia
97.5 to 99.5
41. How cardiac contractions are normally initiated by the electrical impules emerging from what?
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
Sinoatrial node (SA NODE)
Vascular resistance drops and the blood pressure decreases
Pedal pulse
42. Measurement of oxygen
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
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.
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
oximetry
43. Snoring sound produced when patients are unable to cough up secretions from the trachea or bronchi
Stertor
the lungs
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
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.
44. Head injury or any increased intracranial pressure will depress the respiratory center and result in?
Tachypnea
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
shallow or slow breathing
+2
45. Both strong and weak beats occur within 1 minute
bradycardia
60 to 70 mL
thready
Irregular
46. High oxygen
hyperoxia
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
120/80
palpate
47. What affects does aging do to the respiratory rate?
Pedal pulse
Systolic pressure
Core Temperature
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
48. No pulse palpable or heard on ausculation
Temperature will remain below 102 degrees with use of hypothermia blanket
Crisis
absent
Posterior tibial
49. Stage 1 hypertension
Kussmaul's respiration
lysis
140-159/90-99
pyrexia
50. Elderly respiration
Acute anxiety stimulate the nervous system - raising the pulse.
bradypnea
16-20
Nursing interventions to reduce fever