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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.
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. How do emotions increase the pulse rate?
Acute anxiety stimulate the nervous system - raising the pulse.
Respiration
140-159/90-99
Diaphoresis

2. Murmur or swishing sounds that increase as the cuff is deflated
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.
Korotkoff sounds Phase II Swishing
Acute anxiety stimulate the nervous system - raising the pulse.
The pulse rate gradually diminishes from birth to adulthood

3. Whats the best position to take a rectal temperature?
about 1 degree lower than oral temperatures
left Sims position
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
+3

4. BP at or lower 90/60.
the rate - the rhythm - and volume
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.
It will also fall
hypotension

5. State of insufficient oxygen
hypoxia
Korotkoff sounds Phase III: Knocking
Diastolic pressure
Stimulants increase the pulse rate. Depressants decrease the pulse rate.

6. A sudden change or muffling of the sound. (indicates diastolic pressure in children and some adults)
Korotkoff sounds Phase IV: Muffling
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
Biot's respirations
Dorsalis pedis

7. Difficult and labored breathing - can often be accompanied by flared nostrils - anxious appearance - and statements such as I cant get enough air.
hyperoxia
Crisis
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
dyspnea

8. Side of wrist
about 1 degree lower than oral temperatures
about 1 degree higher than oral temperatures
Radial
Stertor

9. Head injury or any increased intracranial pressure will depress the respiratory center and result in?
shallow or slow breathing
absent
The emotions increase hormone secretion - and the body activities required for this increase heat production.
constant

10. How does menstrual cycle and pregnancy raise the body's temperature?
Hyperventilation
temperature - pulse - respiration - blood pressure - and pain level.
The emotions increase hormone secretion - and the body activities required for this increase heat production.
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.

11. The maximum pressure exerted on the artery during left ventricular contraction.
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.
Systolic pressure
the rate - the rhythm - and volume
popliteal

12. Head injury BP?
Diaphoresis
Acute anxiety stimulate the nervous system - raising the pulse.
Core Temperature
raises BP.

13. If blood becomes thicker - like when excessive blood cells are manufactured what happens to BP?
low
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.
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.

14. Adolescent
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.
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
60 to 70 mL
16-20

15. Macine that measures oxygen in the blood by determining the percentage of hemoglobin that is bound with oxygen.
oximeter
Eupnea
higher
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.

16. Encourage a large fluid intake - lower room temperature - increase air circulation - remove items of clothes - control or reduce the amount of body activity - carry out physicians orders
Apical
Nursing interventions to reduce fever
Relapsing
low

17. 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
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.
Diastolic pressure
Korotkoff sounds

18. Risk for prolonged hypertension
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
Cardiac Output
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
Crisis

19. Measurement of oxygen
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
oximetry
Blood pressure increases because there is more volume of blood in the vascular system.
low

20. Side of neck
popliteal
Core Temperature
carotid
Evaporation

21. How cardiac contractions are normally initiated by the electrical impules emerging from what?
orthostatic hypertension
20-30
Hypothermia
Sinoatrial node (SA NODE)

22. Enviromental temperature BP?
Diastolic pressure
pyrogens
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
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.

23. An example of nursing planning
Temporal
orthostatic hypertension
Temperature will remain below 102 degrees with use of hypothermia blanket
hypoxemia

24. Average blood pressure should be
Crisis
120/70
Feeble
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.

25. Korotkoff sounds Ausculatatory gap:
men - African Americans - under a lot of stress - obese
bradypnea
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
It may rise slightly as decreases in vital capacity and respiratory reserve occur.

26. Taking axillary temperature
Cheyenne-Stokes
remittent
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.
Systolic pressure

27. Excessive sweat production
Diaphoresis
Blood pressure increases because there is more volume of blood in the vascular system.
wheeze
140-159/90-99

28. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
Rhonchi
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.
72 bpm
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.

29. Whisting sound of air forced past a partial obstruction - as found in asthma or emphysema.
wheeze
+2
Tachypnea
Feeble

30. Drop in blood pressure when arising to a standing position.
hypertension
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
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

31. Weak and regular (even beats wit poor force)
+1
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
Systolic pressure
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

32. Normal body temperature ranges?
Pulse
Acute anxiety stimulate the nervous system - raising the pulse.
97.5 to 99.5
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.

33. The average temperature in the older adult
96.5 to 97.5
cardiac patients or patients who have had rectal surgery.
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
from drug therapy - a neurologic problem or dehydration.

34. Irregular pulse - a period of normal rhythm broken by periods of irregularity or skipped beats.
arrhythmia
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
fever
low BP

35. By measuring the blood pressure you obtain vital info about what?
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
Korotkoff sounds Phase II Swishing
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
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.

36. Feel
palpate
left Sims position
Korotkoff sounds Phase III: Knocking
low BP

37. Lobes in the lungs?
It increases to push the blood through more rigid pathways.
3 in the right lung and 2 lobes in the left
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.
Crisis

38. What happens whens vasoconstriction causes peripheral vascular resistance to rise?
the blood pressure will rise in order to push the blood along.
hypertension
Posterior tibial
Irregular

39. What happens to the blood if overhydration occurs?
Blood pressure increases because there is more volume of blood in the vascular system.
Acute anxiety stimulate the nervous system - raising the pulse.
shallow or slow breathing
orthostatic hypertension

40. When the heart contracts How many mLs of blood is propelled into the aorta?
oximeter
from drug therapy - a neurologic problem or dehydration.
60 to 70 mL
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.

41. Breathing is an involuntary automatic function controlled by the respiratory center located where?
Pons and Medulla of the brainstem
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
males have higher bp - until menopause then they are the same
Pulse

42. Both strong and weak beats occur within 1 minute
uncooperative patient - children - combative patients - dementia
blood pressure is lowest in the morning. and higher in the afternoone
cardiac patients or patients who have had rectal surgery.
Irregular

43. When should rectal temperatures be used?
remittent
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
uncooperative patient - children - combative patients - dementia
Tachypnea

44. High oxygen
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
hyperoxia
hypotension
Femoral

45. Low oxygen
hypoxia
hypoxemia
stridor
Hyperthermia related to infection or excessive heat exposure

46. A normal - relaxed breathing pattern
lysis
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Cardiac Output
Eupnea

47. 1st stage of fever is?
in the alveoli - tiny thin-walled sacs
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
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
Posterior tibial

48. Healthly adult
12-20
The emotions increase hormone secretion - and the body activities required for this increase heat production.
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Feeble

49. The temperature falls to normal and then rises again in a repeating pattern.
Hypothermia
Kussmaul's respiration
Korotkoff sounds Phase IV: Muffling
Relapsing

50. Crowing sound on inspiration caused by obstruction of the upper air passages - as occurs in croup or laryngitis
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
stridor
120/70
wheeze