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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. A sudden change or muffling of the sound. (indicates diastolic pressure in children and some adults)
Pedal pulse
raises BP.
thready
Korotkoff sounds Phase IV: Muffling

2. Whats the best position to take a rectal temperature?
Pons and Medulla of the brainstem
Hyperventilation
Acute anxiety stimulate the nervous system - raising the pulse.
left Sims position

3. If blood becomes thicker - like when excessive blood cells are manufactured what happens to BP?
Stertor
Apical
Core Temperature
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.

4. Adolescent
Korotkoff sounds
Respiration
16-20
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.

5. What affects does aging do to the respiratory rate?
Tachypnea
hypoxemia
Brachial
It may rise slightly as decreases in vital capacity and respiratory reserve occur.

6. Newborn
96.5 to 97.5
Tall - slender people mayy ave a slower pulse rate than short - stout persons
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
30-80

7. Are infants blood pressure low or high?
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
low
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.

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

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9. 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?
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Temperature will remain below 102 degrees with use of hypothermia blanket
Rhonchi
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.

10. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
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.
Rhonchi
Korotkoff sounds
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.

11. Normal body temperature ranges?
Pulse
97.5 to 99.5
in the alveoli - tiny thin-walled sacs
constant

12. This affects the character of the pulse.
Stroke Volume
bradycardia
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 will remain below 102 degrees with use of hypothermia blanket

13. Full and bounding (even beats wit strong force)
+3
Dorsalis pedis
ausculatation
palpate

14. Feel
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
12-20
palpate
+1

15. BP at or lower 90/60.
uncooperative patient - children - combative patients - dementia
Temporal
Crisis
hypotension

16. The rate at which heat is produced when the body is at rest.
cardiac patients or patients who have had rectal surgery.
Brachial
hypoxia
BMR

17. How is shock caused?
Brachial
12-20
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Korotkoff sounds Phase V: Silence

18. right arm vs. left arm/ arm vs. leg BP?
about 1 degree lower than oral temperatures
BMR
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
low BP

19. How does menstrual cycle and pregnancy raise the body's temperature?
blood pressure is lowest in the morning. and higher in the afternoone
higher
96.5 to 97.5
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.

20. No pulse palpable or heard on ausculation
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
absent
Kussmaul's respiration
lysis

21. Signs and symptoms of shock
Crisis
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
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
oximetry

22. How does external respiration occur?
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.
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
Rhonchi
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

23. What patients should not use a glass thermometer orally?
+2
uncooperative patient - children - combative patients - dementia
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
The emotions increase hormone secretion - and the body activities required for this increase heat production.

24. Absence of breathing
the rate - the rhythm - and volume
apnea
Pulse pressure
shallow or slow breathing

25. Korotkoff sounds Ausculatatory gap:
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
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
Stertor
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.

26. Fever above 100.2 F
Evaporation
pyrexia
shallow or slow breathing
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes

27. When should rectal temperatures be used?
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
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 in the right lung and 2 lobes in the left
the blood pressure will rise in order to push the blood along.

28. Average pulse rate for an adult
intermittent
72 bpm
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
Diaphoresis

29. How do drugs affect pulse?
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
low BP
Cheyenne-Stokes
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.

30. Pulse lower than 60 beats per minute
hypotension
ausculatation
bradycardia
popliteal

31. Head injury or any increased intracranial pressure will depress the respiratory center and result in?
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Femoral
Biot's respirations
shallow or slow breathing

32. Louder knocking sound that occurs wit each heartbeat
Temporal
Korotkoff sounds Phase III: Knocking
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
about 1 degree higher than oral temperatures

33. The difference between the systolic pressure and the diastolic pressure
pyrogens
Acute anxiety stimulate the nervous system - raising the pulse.
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
Pulse pressure

34. Abrupt decline in fever
Hypothermia
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
Nursing interventions to reduce fever
Crisis

35. Pulse above 100 beats per minute
the blood pressure will rise in order to push the blood along.
Rhonchi
tachycardia
Kussmaul's respiration

36. How should baby's temperature be taken?
systolic pressure indicated by faint - clear sound that gradually grow louder.
The pulse rate gradually diminishes from birth to adulthood
Stertor
Axillary.

37. respirations become faster and deeper - then slower and shallower wit a period of apnea - called the death rattle.
Cheyenne-Stokes
Stroke Volume
16-20
Temporal

38. Head injury BP?
140-159/90-99
hypotension
raises BP.
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.

39. Why would patients experience orthostatic hypotenstion?
Tall - slender people mayy ave a slower pulse rate than short - stout persons
from drug therapy - a neurologic problem or dehydration.
carotid
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.

40. People most at risk for hypertension
Tachypnea
Evaporation
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
men - African Americans - under a lot of stress - obese

41. High BP
Korotkoff sounds
hypertension
low BP
3 in the right lung and 2 lobes in the left

42. Obtaining the correct size for a cuff for BP?
120/70
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
Korotkoff sounds Phase V: Silence
Feeble

43. Whisting sound of air forced past a partial obstruction - as found in asthma or emphysema.
bradycardia
wheeze
Temporal
the blood pressure will rise in order to push the blood along.

44. Diurnal variation BP?
blood pressure is lowest in the morning. and higher in the afternoone
Axillary.
crackles
30-80

45. How do you measure the apical pulse?
Temporal
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 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.
higher

46. Prehypertension
120-139/80-89
Diastolic pressure
Apical
Tall - slender people mayy ave a slower pulse rate than short - stout persons

47. Side of neck
Korotkoff sounds Phase IV: Muffling
carotid
16-20
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.

48. 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.
Tachypnea
from drug therapy - a neurologic problem or dehydration.
Temporal
Diastolic pressure

49. Stage 1 hypertension
+2
Rhonchi
140-159/90-99
shallow or slow breathing

50. Murmur or swishing sounds that increase as the cuff is deflated
Korotkoff sounds Phase II Swishing
Diaphoresis
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
Temporal