ATI FUNDAMENTALS VITAL SIGNS
Q&A 2026/2027 UPDATED|
Temperature, Pulse, Respiration
1. A nurse is preparing to assess a client's vital signs. Which action should the
nurse perform FIRST?
• A) Apply the blood pressure cuff
• B) Count the radial pulse
• C) Perform hand hygiene and explain the procedure to the client ✓
• D) Measure the client's temperature
Rational: Before any procedure, the nurse performs hand hygiene and explains
what will be done to reduce anxiety, ensure cooperation, and maintain infection
control. Assessment begins with preparation and client communication .
2. The primary reason for assessing vital signs on an apparently healthy client
during an initial visit is to:
• A) Identify clinical problems
• B) Determine response to therapy
• C) Establish a baseline ✓
• D) Screen for disease
,Rational: When a patient reports no specific health-related problem, the primary
reason for vital sign assessment is to document baseline data. This information will
be useful for comparison with vital-sign data obtained at subsequent visits .
3. Which of the following accurately describes body temperature?
• A) The amount of heat produced by metabolism
• B) The amount of heat lost to the environment
• C) The difference between heat produced by and lost from the body ✓
• D) The temperature of the skin surface
Rational: Normal body temperature is the healthy balance between the amounts of
heat the body produces (as a byproduct of metabolism, muscle activity, thyroxine
output, and sympathetic stimulation) and the heat lost (as a result of radiation,
conduction, convection, and evaporation) .
4. The four main vital signs are:
• A) Temperature, pulse, respiration, and pain level
• B) Temperature, pulse, respiration, and blood pressure ✓
• C) Temperature, pulse, blood pressure, and oxygen saturation
• D) Pulse, respiration, blood pressure, and pain
Rational: The four main vital signs are temperature, pulse, respiration, and blood
pressure. Pain level and oxygen saturation are often considered additional or "fifth"
vital signs .
,5. A nurse documents a client's temperature as 99.6°F (O). This indicates:
• A) The temperature was taken rectally
• B) The temperature was taken orally ✓
• C) The temperature was taken axillary
• D) The temperature was taken tympanically
Rational: In documentation, (O) indicates oral temperature, (R) indicates rectal,
(Ax) indicates axillary, and (T) indicates tympanic. 99.6°F is within the normal oral
temperature range .
6. Which vital sign reflects the balance between heat produced and heat lost?
• A) Pulse
• B) Respiration
• C) Temperature ✓
• D) Blood pressure
Rational: Temperature reflects the balance between heat produced by the body
and heat lost to the environment. The body maintains a relatively constant internal
temperature through thermoregulation .
7. Normal adult temperature range (oral) is:
• A) 96.0°F to 98.0°F
• B) 97.6°F to 99.6°F ✓
, • C) 98.6°F to 100.6°F
• D) 99.0°F to 101.0°F
Rational: The normal range for oral temperature in adults is 97.6-99.6 degrees
Fahrenheit .
8. A client's temperature is 101.0°F (O). This would be documented as:
• A) Normal
• B) Subnormal
• C) Febrile ✓
• D) Hypothermic
Rational: A temperature above 100.4°F (38°C) is considered febrile (fever). Normal
oral temperature range is 97.6-99.6°F .
9. Which temperature site is considered closest to core temperature?
• A) Oral
• B) Axillary
• C) Tympanic ✓
• D) Skin
Rational: Tympanic (aural) temperature measures the temperature of the tympanic
membrane and ear canal and comes closest to measuring the body's core
temperature .
Q&A 2026/2027 UPDATED|
Temperature, Pulse, Respiration
1. A nurse is preparing to assess a client's vital signs. Which action should the
nurse perform FIRST?
• A) Apply the blood pressure cuff
• B) Count the radial pulse
• C) Perform hand hygiene and explain the procedure to the client ✓
• D) Measure the client's temperature
Rational: Before any procedure, the nurse performs hand hygiene and explains
what will be done to reduce anxiety, ensure cooperation, and maintain infection
control. Assessment begins with preparation and client communication .
2. The primary reason for assessing vital signs on an apparently healthy client
during an initial visit is to:
• A) Identify clinical problems
• B) Determine response to therapy
• C) Establish a baseline ✓
• D) Screen for disease
,Rational: When a patient reports no specific health-related problem, the primary
reason for vital sign assessment is to document baseline data. This information will
be useful for comparison with vital-sign data obtained at subsequent visits .
3. Which of the following accurately describes body temperature?
• A) The amount of heat produced by metabolism
• B) The amount of heat lost to the environment
• C) The difference between heat produced by and lost from the body ✓
• D) The temperature of the skin surface
Rational: Normal body temperature is the healthy balance between the amounts of
heat the body produces (as a byproduct of metabolism, muscle activity, thyroxine
output, and sympathetic stimulation) and the heat lost (as a result of radiation,
conduction, convection, and evaporation) .
4. The four main vital signs are:
• A) Temperature, pulse, respiration, and pain level
• B) Temperature, pulse, respiration, and blood pressure ✓
• C) Temperature, pulse, blood pressure, and oxygen saturation
• D) Pulse, respiration, blood pressure, and pain
Rational: The four main vital signs are temperature, pulse, respiration, and blood
pressure. Pain level and oxygen saturation are often considered additional or "fifth"
vital signs .
,5. A nurse documents a client's temperature as 99.6°F (O). This indicates:
• A) The temperature was taken rectally
• B) The temperature was taken orally ✓
• C) The temperature was taken axillary
• D) The temperature was taken tympanically
Rational: In documentation, (O) indicates oral temperature, (R) indicates rectal,
(Ax) indicates axillary, and (T) indicates tympanic. 99.6°F is within the normal oral
temperature range .
6. Which vital sign reflects the balance between heat produced and heat lost?
• A) Pulse
• B) Respiration
• C) Temperature ✓
• D) Blood pressure
Rational: Temperature reflects the balance between heat produced by the body
and heat lost to the environment. The body maintains a relatively constant internal
temperature through thermoregulation .
7. Normal adult temperature range (oral) is:
• A) 96.0°F to 98.0°F
• B) 97.6°F to 99.6°F ✓
, • C) 98.6°F to 100.6°F
• D) 99.0°F to 101.0°F
Rational: The normal range for oral temperature in adults is 97.6-99.6 degrees
Fahrenheit .
8. A client's temperature is 101.0°F (O). This would be documented as:
• A) Normal
• B) Subnormal
• C) Febrile ✓
• D) Hypothermic
Rational: A temperature above 100.4°F (38°C) is considered febrile (fever). Normal
oral temperature range is 97.6-99.6°F .
9. Which temperature site is considered closest to core temperature?
• A) Oral
• B) Axillary
• C) Tympanic ✓
• D) Skin
Rational: Tympanic (aural) temperature measures the temperature of the tympanic
membrane and ear canal and comes closest to measuring the body's core
temperature .
