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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. What patients should not use a glass thermometer orally?
120-139/80-89
uncooperative patient - children - combative patients - dementia
fever
stridor

2. Elderly respiration
Defervescence - lowering of the body temperature to normal. The person feels warm and the skin may be moist.
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
16-20
+2

3. Groin area
Systolic pressure
Rhonchi
Femoral
30-80

4. What affects does aging do to the respiratory rate?
96.5 to 97.5
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
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.
Vascular resistance drops and the blood pressure decreases

5. Pulse lower than 60 beats per minute
hypoxemia
bradycardia
wheeze
Sinoatrial node (SA NODE)

6. When should rectal temperatures NOT be used?
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.
Korotkoff sounds Phase II Swishing
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
cardiac patients or patients who have had rectal surgery.

7. 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
Korotkoff sounds Phase V: Silence
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.
Femoral

8. How is shock caused?
dyspnea
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
in the alveoli - tiny thin-walled sacs
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients

9. Gas exchange in the blood occurs where?
ausculatation
Biot's respirations
temperature - pulse - respiration - blood pressure - and pain level.
in the alveoli - tiny thin-walled sacs

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

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11. What affects does aging do to the blood pressure?
Crisis
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
shallow or slow breathing
+3

12. Fast - deep respirations with abrupt pauses

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13. Korotkoff sounds Ausculatatory gap:
Cheyenne-Stokes
Hyperthermia related to infection or excessive heat exposure
Convection
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients

14. Top of left foot
Dorsalis pedis
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.
Respiration
Stroke Volume

15. Korotkoff sounds Phase I: Tapping
Acute anxiety stimulate the nervous system - raising the pulse.
systolic pressure indicated by faint - clear sound that gradually grow louder.
wheeze
hyperoxia

16. Increased rate and depth with panting and long grunting exhalation. Often seen with patients with acidosis and renal failure.

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17. Continuous dry - rattling sounds heard on ausculation of the lungs caused by partial obstruction.
12-20
120/80
Rhonchi
Temporal

18. Whats the best position to take a rectal temperature?
left Sims position
Diaphoresis
orthostatic hypertension
Sinoatrial node (SA NODE)

19. Those at risk for hypothermia include
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.
hypotension
popliteal
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.

20. The difference between the systolic pressure and the diastolic pressure
Pulse pressure
from drug therapy - a neurologic problem or dehydration.
Sinoatrial node (SA NODE)
Biot's respirations

21. Sex BP?
palpate
It will also fall
males have higher bp - until menopause then they are the same
low BP

22. Taking a rectal temperature
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds
Wash hands - don gloves - lubricate probe - Insert .5 to 1.5 inches. Hold in place for 3 to 5 minutes.
hypoxemia
Core Temperature

23. Stage 1 hypertension
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
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
140-159/90-99
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients

24. Symptoms of hypoxia
low BP
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
Core Temperature
restlessness & apprehension - confusion - dizziness - and change in level of consciousness - cyanosis or skin color changes - particularly around the mouth and in the nail beds

25. Bend of knee
Nursing interventions to reduce fever
popliteal
left Sims position
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.

26. Weak and may be irregular
Relapsing
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
thready
blood pressure is lowest in the morning. and higher in the afternoone

27. What should you do if you cannot determine BP by ausculation?
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.
20-30
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.
The pulse rate gradually diminishes from birth to adulthood

28. Are infants blood pressure low or high?
low
120/80
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
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.

29. 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
120/80
Conduction
Temperature will remain below 102 degrees with use of hypothermia blanket

30. Absence of breathing
Increases as body tries to remove excess heat
oximetry
Respiration
apnea

31. This affects the character of the pulse.
shallow or slow breathing
Stroke Volume
Convection
stridor

32. Axillary temperature are
about 1 degree lower than oral temperatures
men - African Americans - under a lot of stress - obese
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.
palpate

33. How does menstrual cycle and pregnancy raise the body's temperature?
Convection
males have higher bp - until menopause then they are the same
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.
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.

34. The exchange of oxygen and carbon dioxide in the lungs and tissues and is initiated by the act of breathing.
intermittent
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.
Respiration
It doesn't change in a healthy elderly patient but the pattern rhythm may be slightly irregular.

35. Abrupt decline in fever
Acute anxiety stimulate the nervous system - raising the pulse.
from drug therapy - a neurologic problem or dehydration.
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.
Crisis

36. Murmur or swishing sounds that increase as the cuff is deflated
Korotkoff sounds Phase II Swishing
Korotkoff sounds
the lungs
+2

37. Side of forehead
Temporal
Cardiac Output
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.

38. Disappearance of sound. (marks diastolic pressure in adults)
Eupnea
Pulse
Korotkoff sounds Phase V: Silence
orthostatic hypertension

39. When the vascular walls lose elasticity - as with arteriosclerosis and aging what happens to BP?
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.
It increases to push the blood through more rigid pathways.
hyperoxia
shallow or slow breathing

40. The rate at which heat is produced when the body is at rest.
The pulse rate gradually diminishes from birth to adulthood
males have higher bp - until menopause then they are the same
about 1 degree lower than oral temperatures
BMR

41. When warm skin touches a cool object - heat is lost to the object.
Irregular
Cheyenne-Stokes
Rhonchi
Conduction

42. Decreased levels of oxygen in the blood - often seen in patients wo are under medical sedation - who are recovering from anesthesia or abdominal surgery - or who are in a weak or debiliated condition.
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.
systolic pressure indicated by faint - clear sound that gradually grow louder.
140-159/90-99
hypoxemia

43. The maximum pressure exerted on the artery during left ventricular contraction.
the rate - the rhythm - and volume
palpate
Cheyenne-Stokes
Systolic pressure

44. High BP
140-159/90-99
pyrexia
It may rise slightly as decreases in vital capacity and respiratory reserve occur.
hypertension

45. Head injury BP?
Korotkoff sounds Phase III: Knocking
Cheyenne-Stokes
raises BP.
Korotkoff sounds Phase V: Silence

46. An example of nursing planning
Temperature will remain below 102 degrees with use of hypothermia blanket
shallow or slow breathing
120/80
lysis

47. Elevated temperature
remittent
males have higher bp - until menopause then they are the same
Diastolic pressure
fever

48. How does age affect pulse?
dyspnea
decrease BP - increase pulse rate - cold and clammy skin - dizziness - blurred vision - and apprehension.
The pulse rate gradually diminishes from birth to adulthood
72 bpm

49. A sudden change or muffling of the sound. (indicates diastolic pressure in children and some adults)
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
Tachypnea
Radial
Korotkoff sounds Phase IV: Muffling

50. Newborn
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
apnea
Pedal pulse
30-80