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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. How cardiac contractions are normally initiated by the electrical impules emerging from what?
Sinoatrial node (SA NODE)
Temperature will remain below 102 degrees with use of hypothermia blanket
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.
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients

2. Does the respiration rate increase or decrease during fever?
^160/^100
Increases as body tries to remove excess heat
arrhythmia
cardiac patients or patients who have had rectal surgery.

3. Excessive sweat production
Cardiac Output
Diaphoresis
Pons and Medulla of the brainstem
fever

4. 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.
arrhythmia
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.
Stroke volume
hypoxemia

5. Enviromental temperature BP?
remittent
low
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.

6. Heart
Apical
bradycardia
men - African Americans - under a lot of stress - obese
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.

7. Risk for prolonged hypertension
pyrogens
It increases to push the blood through more rigid pathways.
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
hyperoxia

8. Difficult and labored breathing - can often be accompanied by flared nostrils - anxious appearance - and statements such as I cant get enough air.
Core Temperature
Hyperventilation
Feeble
dyspnea

9. Newborn
30-80
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
Korotkoff sounds Phase III: Knocking
cardiac patients or patients who have had rectal surgery.

10. Korotkoff sounds Phase I: Tapping
Conduction
systolic pressure indicated by faint - clear sound that gradually grow louder.
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.
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.

11. 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.
low BP
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
30-80

12. While measuring the BP certain sounds may be heard that relate to the effect of the blood pressure cuff on the arterial wall.
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.
Korotkoff sounds
tachycardia
the lungs

13. Prehypertension
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.
120-139/80-89
Pulse
Stimulants increase the pulse rate. Depressants decrease the pulse rate.

14. Korotkoff sounds Ausculatatory gap:
silence as cuff deflates for 30 to 40 mm Hg; common with hypertension and elderly patients
Femoral
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.
intermittent

15. Gas exchange in the blood occurs where?
in the alveoli - tiny thin-walled sacs
fever
Nursing interventions to reduce fever
60 to 70 mL

16. Taking axillary temperature
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.
oximetry
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
Stertor

17. This affects the character of the pulse.
crackles
Stroke Volume
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
Blood pressure increases because there is more volume of blood in the vascular system.

18. Abrupt decline in fever
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
Convection
Crisis
+1

19. Heat is lost from the body by evaporation. resulting in a daily loss of 800mL of water from skin and lungs.
Crisis
carotid
Evaporation
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.

20. 2nd stage of fever is?
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.
Respiration
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
palpate

21. Groin area
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.
Femoral
about 1 degree higher than oral temperatures
Biot's respirations

22. Feel
palpate
Convection
Korotkoff sounds Phase III: Knocking
12-20

23. What patients should not use a glass thermometer orally?
men - African Americans - under a lot of stress - obese
BMR
Diaphoresis
uncooperative patient - children - combative patients - dementia

24. How does physical exercise raise the body's temperature?
dyspnea
Tall - slender people mayy ave a slower pulse rate than short - stout persons
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.
Diaphoresis

25. Both strong and weak beats occur within 1 minute
Irregular
Crisis
constant
intermittent

26. Blood pressure for any adult should be no higher than
120/80
Nursing interventions to reduce fever
16-20
low BP

27. Abnormal - nonmusical sound heard on ausculation of the lungs during inspiration; also called rales. Sound like hair rubbed between the fingers next to the ears.
Pulse pressure
Stimulants increase the pulse rate. Depressants decrease the pulse rate.
Korotkoff sounds Phase III: Knocking
crackles

28. Inside ankle
Core Temperature
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 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.
Posterior tibial

29. What characteristics should be noted when checking the pulse?
the lungs
the rate - the rhythm - and volume
Korotkoff sounds Phase IV: Muffling
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

30. Elevated temperature
pyrexia
The systolic blood pressure rises slightly because the arota and major arteries tend to harden with age. The diastolic pressure rises also.
Sinoatrial node (SA NODE)
fever

31. State of insufficient oxygen
stridor
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.
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
hypoxia

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

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33. Murmur or swishing sounds that increase as the cuff is deflated
Korotkoff sounds Phase IV: Muffling
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.
72 bpm
Korotkoff sounds Phase II Swishing

34. The rate at which heat is produced when the body is at rest.
Tall - slender people mayy ave a slower pulse rate than short - stout persons
BMR
thready
the blood pressure will rise in order to push the blood along.

35. The difference between the systolic pressure and the diastolic pressure
fever
Feeble
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
Pulse pressure

36. Pulse lower than 60 beats per minute
The pulse rate increases at the rate of 7-10 beats for each degree of temperature
Conduction
the proper cuff is 21% bigger than the diameter of the arm. the inflatable bladder should go around 3/4 of the arm.
bradycardia

37. How does external respiration occur?
Relapsing
if its hot bp can lower because of vasodilation. if its cold it can rise because of vasoconstriction.
+2
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

38. How should baby's temperature be taken?
Vascular resistance drops and the blood pressure decreases
Axillary.
stridor
low BP

39. Normal body temperature ranges?
males have higher bp - until menopause then they are the same
97.5 to 99.5
in the alveoli - tiny thin-walled sacs
fever

40. Crowing sound on inspiration caused by obstruction of the upper air passages - as occurs in croup or laryngitis
The pulse rate gradually diminishes from birth to adulthood
stridor
hemorrhage - vomiting - diarrhea - burns - and myocardial infarctions.
Stroke volume

41. No pulse palpable or heard on ausculation
about 1 degree lower than oral temperatures
absent
Korotkoff sounds
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.

42. What happens to the blood if overhydration occurs?
+2
arrhythmia
Blood pressure increases because there is more volume of blood in the vascular system.
Radial

43. 1st stage of fever is?
The emotions increase hormone secretion - and the body activities required for this increase heat production.
bradypnea
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
Irregular

44. Carbon dioxide is carried as bicarbonate ion in the blood until it reaches where?
permanent damage to the heart - the brain - the kidneys - and the retina of the eye - may cause strokes
Radial
the lungs
Body temperature drops before ovulation and rises 1 degree above normal during ovulation. During pregnancy the body temperature is slightly higher.

45. Why would patients experience orthostatic hypotenstion?
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.
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.
from drug therapy - a neurologic problem or dehydration.
the blood pressure will rise in order to push the blood along.

46. How does emotional stress raise the body's temperature?
The emotions increase hormone secretion - and the body activities required for this increase heat production.
Increases as body tries to remove excess heat
Korotkoff sounds Phase II Swishing
Respiration

47. Breathing is an involuntary automatic function controlled by the respiratory center located where?
the BP goes up because more pressure is needed to push the thicker fluid through the vascular system.
Pons and Medulla of the brainstem
lysis
low BP

48. High oxygen
Korotkoff sounds
hyperoxia
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
higher

49. What are the 5 vital signs?
temperature - pulse - respiration - blood pressure - and pain level.
Pulse
97.5 to 99.5
30 seconds and multiplied by 2. unless the person is very sick or has resp. problems you should count for one full minute.

50. Absence of breathing
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.
apnea
variation of about 5-10 between arms. and a 10-40 difference in systolic pressure with leg & arm.
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