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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.
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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)
+3
Korotkoff sounds Phase IV: Muffling
Axillary.
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.

2. Irregular pulse - a period of normal rhythm broken by periods of irregularity or skipped beats.
popliteal
arrhythmia
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Systolic pressure

3. Newborn
oximeter
Hyperventilation
30-80
It may rise slightly as decreases in vital capacity and respiratory reserve occur.

4. What will happen in febrile stage if temperature is very high or temperature stays for a long amount of time?
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.
bradycardia
constant
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

5. Barely palpable
Feeble
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
Korotkoff sounds Phase III: Knocking
140-159/90-99

6. Bend of elbow
It will also fall
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
Brachial
the blood pressure will rise in order to push the blood along.

7. Sex BP?
wheeze
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
Hyperventilation
males have higher bp - until menopause then they are the same

8. How should baby's temperature be taken?
Kussmaul's respiration
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
bradypnea
Axillary.

9. Enviromental temperature BP?
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
blood pressure is lowest in the morning. and higher in the afternoone
Biot's respirations

10. The temperature falls to normal and then rises again in a repeating pattern.
Hyperventilation
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.
Relapsing
12-20

11. The lower pressure exerted on the artery when the heart is at rest inbetween contractions.
Diastolic pressure
hypoxia
arrhythmia
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.

12. Adolescent
3 in the right lung and 2 lobes in the left
fever
constant
16-20

13. What characteristics should be noted when checking the pulse?
The pulse rate gradually diminishes from birth to adulthood
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
left Sims position
the rate - the rhythm - and volume

14. Side of neck
tachycardia
carotid
Acute anxiety stimulate the nervous system - raising the pulse.
the rate - the rhythm - and volume

15. While measuring the BP certain sounds may be heard that relate to the effect of the blood pressure cuff on the arterial wall.
absent
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
Korotkoff sounds
Stroke Volume

16. Bend of knee
It increases to push the blood through more rigid pathways.
Because fever is a protective defense mechanisms that the body uses to fight pathogens and their toxins the inflammatory response produces fevers.
120/70
popliteal

17. The pulse rate multiplied by the stroke volume. This is the amount of blood pumped by the left ventricle in 1 minute. Averaging at about 5mL per minute.
Increases as body tries to remove excess heat
Cardiac Output
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.
Radial

18. right arm vs. left arm/ arm vs. leg BP?
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
constant
Feeble
carotid

19. Breathing is an involuntary automatic function controlled by the respiratory center located where?
Pons and Medulla of the brainstem
Irregular
hypoxemia
Nursing interventions to reduce fever

20. Shock - hemorrhage - low cardiac output - inadequate volume of blood?
low BP
Systolic pressure
Crisis
96.5 to 97.5

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

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22. What affects does aging do to the respiratory rate?
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
absent
apnea
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.

23. 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?
low BP
pulse deficit - the radial pulse subtracted from the apical pulse equals the pulse deficit.
30-80
blood pressure is lowest in the morning. and higher in the afternoone

24. How does size affect pulse?
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.
Tall - slender people mayy ave a slower pulse rate than short - stout persons
in the alveoli - tiny thin-walled sacs
Axillary.

25. High BP
BMR
Diaphoresis
hypertension
12-20

26. Fast - deep respirations with abrupt pauses

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27. 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.
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
hypotension
Temporal
Hypothermia

28. Slow and shallow breathing - leads to hypoxemia.
bradypnea
constant
Temperature will remain below 102 degrees with use of hypothermia blanket
Pedal pulse

29. When the heart contracts How many mLs of blood is propelled into the aorta?
males have higher bp - until menopause then they are the same
hyperoxia
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
60 to 70 mL

30. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
Stertor
blood pressure is lowest in the morning. and higher in the afternoone
Rhonchi
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.

31. Stress & emotions. BP?
higher
Dorsalis pedis
tachycardia
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.

32. Low oxygen
Eupnea
hypoxia
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.
remittent

33. The temperature is continuously elevated with less than 1 degree of variation within a 24-hour period.
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
constant
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
about 1 degree higher than oral temperatures

34. Full and bounding (even beats wit strong force)
+3
Korotkoff sounds Phase III: Knocking
fever
cardiac patients or patients who have had rectal surgery.

35. Drop in blood pressure when arising to a standing position.
pyrogens
Pedal pulse
orthostatic hypertension
oximeter

36. 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
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.
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Conduction

37. What affects does aging do to the blood pressure?
120/80
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
Axillary.
Temporal

38. Side of wrist
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
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Stroke volume
Radial

39. Whats the best position to take a rectal temperature?
hypoxia
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
3 in the right lung and 2 lobes in the left
left Sims position

40. What happens to the blood if overhydration occurs?
Blood pressure increases because there is more volume of blood in the vascular system.
absent
Pulse
orthostatic hypertension

41. Those at risk for hypothermia include
Apical
Korotkoff sounds Phase III: Knocking
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.
ausculatation

42. Side of forehead
The emotions increase hormone secretion - and the body activities required for this increase heat production.
pyrexia
Temporal
Feeble

43. How do emotions increase the pulse rate?
Acute anxiety stimulate the nervous system - raising the pulse.
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.
Dorsalis pedis
intermittent

44. Air movemtn causes heat to be transferred from the skin to the air molecules.
16-20
Pulse
Tall - slender people mayy ave a slower pulse rate than short - stout persons
Convection

45. Weak and regular (even beats wit poor force)
tachycardia
raises BP.
+1
Conduction

46. An example of a nursing diagnoses
Hyperthermia related to infection or excessive heat exposure
20-30
in the alveoli - tiny thin-walled sacs
Respiration

47. What happens whens vasoconstriction causes peripheral vascular resistance to rise?
Tachypnea
Hyperventilation
low BP
the blood pressure will rise in order to push the blood along.

48. Measurement of oxygen
oximetry
Convection
It increases to push the blood through more rigid pathways.
Respiration

49. Head injury BP?
raises BP.
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.
fever
Temperature will remain below 102 degrees with use of hypothermia blanket

50. An example of nursing planning
Korotkoff sounds Phase III: Knocking
Temperature will remain below 102 degrees with use of hypothermia blanket
Diastolic pressure
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.

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Measuring Vital Signs

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