Week 3: Vital Signs Assessment

Question 1

The … … occurs in some people with …. This is an absence of … sounds for a space between …. and …. mmHg when the cuff pressure is high.

Answer 1

The auscultatory gap occurs in some people with hypertension. This is an absence of Korotoff’s sounds for a space between 40 and 40mmHg when the cuff pressure is high.

Question 2

An adult patient with a BP of 89/40 will need:

A) a rapid response call
B) a review by the medical officer on their next round
C) re-assessment of their BP after 30 mins to decide on required care
D) a clinical review call

Answer 2

A) A rapid response call

Question 3

Which of the following positions does the RN assist the client in to best assess respiratory status?

A) Supine
B) Semi-Fowler’s
C) Prone
D) Side-lying

Answer 3

B) Semi-Fowler’s

Question 4

Which of the following arteries iss most commonly used to obtain a blood pressure reading?

A) Femoral
B) Brachial
C) Radial
D) Ulnar

Answer 4

B) Brachial

Question 5

When assessing a client’s peripheral pulse, the health care provider is also assessing which of the following?

A) Sound
B) Depth
C) Rhythm
D) Stress

Answer 5

C) Rhythm

Question 6

Which of the following factors can affect oxygen saturation readings?

A) Nutrition
B) Skin colour
C) Activity
D) Hot beverages

Answer 6

C) Activity

Question 7

Respiratory rate is regulated by all of the following except:

A) Diaphragm movement
B) Medulla oblongata
C) chemoreceptors
D) carotid pressure

Answer 7

D) Carotid pressure

Question 8

Which of the following statements about measuring blood pressure is false?

A) the patient should be allowed to rest for at least 5 mins after activity before taking their blood pressure
B) the upper arm, above the elbow, is most commonly used to obtain a BP measurement
C) Apply the cuff directly over the radial artery to ensure proper pressure is applied during inflation
D) the upper arm should be fully exposed so that the cuff can be properly applied

Answer 8

C) Apply the cuff directly over the radial artery to ensure proper pressure is applied during inflation

Question 9

All of the following are nursing considerations for determining respiratory rate except:

A) assessing the rate, rhythm, regularity and depth of respirations
B) endeavoring to assess the respiratory rate whilst the patient is unaware that you are undertaking this assessment
C) Ensuring the patient stands with their feet spread to align with their shoulders
D) Ensuring the patient is in a supine position

Answer 9

D) Ensuring that the patient is in a supine position

Question 10

The systolic sound when taking blood pressure is identified as
A) None of the available options
B) a crisp and intense sound
C) a tapping sound that takes on a swishing quality
D) soft muffled sound
E) the last clear tapping sounds that gradually lessens in intensity
F) the first clear tapping sounds that gradually intensifies

Answer 10

F) The first clear tapping sounds that gradually intensifies