Chap 13 Vital Signs

Question 1

Apical pulse

Answer 1

Taken with stethoscope over heart

Question 2

Parameters for temperature, thermometer types

Answer 2

Blue/green - oral, axillary
Red - rectal
Axillary - 96.6-98.6F or 36-37C
Oral - 97.6-99.6F or 36.5-37.5C
Rectal - 98.6-100.6F or 37-38

Question 3

Parameters for pulse - 4

Answer 3

Only apical pulse uses stethoscope
60-100 BPM normal
Count 30 seconds.  If 30-50, double, and you are done
Otherwise continue to 60 seconds
Bradycardia, Tachycardia

Question 4

Parameters for Respiration - 3

Answer 4

12-20 inhale/exhale cycles per minute normal
Count 30 seconds. If 6-10, double and done.
Else count all 60 seconds.
Bradypnea, Tachypnea

Question 5

Places to take pulse - 8

Answer 5

Temporal, Carotid
Apical
Brachial, Radial
Femoral, Popliteal, Pedal

Question 6

Parameters for BP -

Answer 6

Normal systolic/diastolic 100-120 over 60-80
Hypertension 140/90 and up
Hypotension below 100/60
Prehypertension 120-139 over 80-89
If way out, wait 5 minutes and try again

Question 7

Parameters for pain

Answer 7

Scale 0-10
0-3 mild
4-6 moderate
7-9 severe
10 excruciating
Warm milk helps

Question 8

Factors that affect body temperature - 6

Answer 8

Person's age
Amount of exercise
Circadian rhythm
Stress
Illness
Environment

Question 9

Signs/symptoms of hypothermia - 7

Answer 9

Shivering
Numbness
Quick and shallow breathing
Slow movements
Mild confusion
Changes in mental status
Pale and/or cyanotic skin

Question 10

Main sites to take temperature - 4

Answer 10

Oral, rectum, axillary, ear

Question 11

Common types of thermometer - 6

Answer 11

Mercury-free
Digital
Electronic
Disposable
Tympanic
Temporal artery

Question 12

Do not take oral temperature if - 10

Answer 12

Unconscious
Using oxygen
Confused or disoriented
Paralyzed from stroke
Facial trauma
Likely to have seizure
Has nasogastric or orogastric tube
Younger than 6 years old
Has sores, redness, swelling, or pain in mouth
Injury to face or neck

Question 13

Special instruction for rectal thermometer

Answer 13

Hold in place the entire time

Question 14

Blood pressure affected by - 10

Answer 14

Age, exercise, stress
Race, heredity
Obesity/unhealthy diet
Alcohol, tobacco
Time of day
Illness

Question 15

Do not take BP on arm (KNOW ALL) - 9

Answer 15

IV present, Arm in use for dialysis
Amputation, Arm has a cast
Arm or side has recent trauma, Burns or injuries present
Arm or side paralyzed due to stroke, Arm or side had any breast surgery
Cuff does not fit the arm properly