HGTC NUR 101 COMPLETE EXAM REVIEW
WITH FULL SOLUTIONS
●● A clients vital signs at the beginning of the shift are as follows: oral
temperature 99.3F (37C), heart rate 82 beats/min, respiratory rate 14
breaths/min, and blood pressure 118/76 mm Hg. Four hours later the
clients oral temperature is 102.2F (39C). Based on the temperature
change, the nurse should anticipate the clients heart rate would be how
many beats/min?
1) 62
2) 82
3) 102
4) 122
Answer: ANS: 3) 102
Heart rate increases about 10 beats per minute for each degree of
temperature to meet increased metabolic needs and compensate for
peripheral dilation.
●● The nurse is assessing vital signs for a client after surgical procedure
on the left leg. IV fluids are infusing. It would be most important for the
nurse to
,1) Compare the left pedal pulse with the right pedal pulse
2) Count the clients respiratory rate for 1 full minute
3) Take the blood pressure in the arm without an IV
4) Take an oral temperature with an electronic thermometer
Answer: ANS: 1) Compare the left pedal pulse with the right pedal pulse
For a client having surgery on the leg, the most important data would be
whether the circulation has been compromised because of the surgery.
This can be done only by comparing one leg with the other. The nurse
would, of course, count the respiratory rate for 1 full minute and take the
BP in the arm without the IV. Oral temperatures are commonly obtained
using electronic thermometers.
●● The nurse hears rhonchi when auscultating a clients lungs. Which
nursing intervention would be appropriate for the nurse to implement
before reassessing lung sounds?
1) Have the client take several deep breaths.
2) Request the client take a deep breath and cough.
3) Take the clients blood pressure and apical pulse.
4) Count the clients respiratory rate for 1 minute.
Answer: ANS: 2) Request the client take a deep breath and cough.
,Rhonchi are caused by secretions in the large airways and may clear
with coughing. This is how you differentiate between rhonchi and other
adventitious sounds. Deep breathing will not help to clear rhonchi.
Taking the blood pressure and apical pulse and counting the respiratory
rate are not effective for clearing rhonchi and would not be sufficient for
the nurse to identify whether the sounds were, indeed, rhonchi.
●● Which of the following sets of vital signs are all within normal limits
for patients at rest?
1) Infant: T 98.8F (rectal), HR 160, RR 16, BP 120/54
2) Adolescent: T 98.2F (oral), HR 80, RR 18, BP 108/68
3) Adult: T 99.6F (oral), HR 48, RR 22, BP 130/84
4) Older adult: T 98.6F (oral), HR 110, RR 28, BP 170/95
Answer: ANS: 2) Adolescent: T 98.2F (oral), HR 80, RR 18, BP 108/68
All of the adolescents vital signs are within normal parameters for the
age. The infants temperature is below normal for a rectal reading
because the core temperature is approximately 1 degree higher than
readings from other sites. The heart rate (HR) for an infant is high, the
respiratory rate (RR) is low, and the blood pressure (BP) is high for the
age. For the typical adult, the temperature is high, the HR is low, the RR
is high, and the BP is elevated for the age. For the older adult, the
temperature is high-end normal, the HR is high, the RR is high, and the
BP is high for the age.
, ●● The nurse assesses the following changes in a clients vital signs.
Which client situation should be reported to the primary care provider?
1)Decreased blood pressure (BP) after standing up
2)Decreased temperature after a period of diaphoresis
3)Increased heart rate after walking down the hall
4)Increased respiratory rate when the heart rate increases
Answer: ANS: 1)Decreased blood pressure (BP) after standing up
A drop in the clients blood pressure when standing indicates orthostatic
hypotension, and the cause should be investigated. The changes in vital
signs indicated in the other options are normal changes for the situations.
PTS:1DIF:ModerateREF:p. 439 for hypotension information but should
read content about all of the vital signs
●● The clients temperature is 101.1F. Which is the correct conversion to
centigrade?
1)38.0C
2)38.4C
3)38.8C
4)39.2C
Answer: ANS: 2) 38.4C
WITH FULL SOLUTIONS
●● A clients vital signs at the beginning of the shift are as follows: oral
temperature 99.3F (37C), heart rate 82 beats/min, respiratory rate 14
breaths/min, and blood pressure 118/76 mm Hg. Four hours later the
clients oral temperature is 102.2F (39C). Based on the temperature
change, the nurse should anticipate the clients heart rate would be how
many beats/min?
1) 62
2) 82
3) 102
4) 122
Answer: ANS: 3) 102
Heart rate increases about 10 beats per minute for each degree of
temperature to meet increased metabolic needs and compensate for
peripheral dilation.
●● The nurse is assessing vital signs for a client after surgical procedure
on the left leg. IV fluids are infusing. It would be most important for the
nurse to
,1) Compare the left pedal pulse with the right pedal pulse
2) Count the clients respiratory rate for 1 full minute
3) Take the blood pressure in the arm without an IV
4) Take an oral temperature with an electronic thermometer
Answer: ANS: 1) Compare the left pedal pulse with the right pedal pulse
For a client having surgery on the leg, the most important data would be
whether the circulation has been compromised because of the surgery.
This can be done only by comparing one leg with the other. The nurse
would, of course, count the respiratory rate for 1 full minute and take the
BP in the arm without the IV. Oral temperatures are commonly obtained
using electronic thermometers.
●● The nurse hears rhonchi when auscultating a clients lungs. Which
nursing intervention would be appropriate for the nurse to implement
before reassessing lung sounds?
1) Have the client take several deep breaths.
2) Request the client take a deep breath and cough.
3) Take the clients blood pressure and apical pulse.
4) Count the clients respiratory rate for 1 minute.
Answer: ANS: 2) Request the client take a deep breath and cough.
,Rhonchi are caused by secretions in the large airways and may clear
with coughing. This is how you differentiate between rhonchi and other
adventitious sounds. Deep breathing will not help to clear rhonchi.
Taking the blood pressure and apical pulse and counting the respiratory
rate are not effective for clearing rhonchi and would not be sufficient for
the nurse to identify whether the sounds were, indeed, rhonchi.
●● Which of the following sets of vital signs are all within normal limits
for patients at rest?
1) Infant: T 98.8F (rectal), HR 160, RR 16, BP 120/54
2) Adolescent: T 98.2F (oral), HR 80, RR 18, BP 108/68
3) Adult: T 99.6F (oral), HR 48, RR 22, BP 130/84
4) Older adult: T 98.6F (oral), HR 110, RR 28, BP 170/95
Answer: ANS: 2) Adolescent: T 98.2F (oral), HR 80, RR 18, BP 108/68
All of the adolescents vital signs are within normal parameters for the
age. The infants temperature is below normal for a rectal reading
because the core temperature is approximately 1 degree higher than
readings from other sites. The heart rate (HR) for an infant is high, the
respiratory rate (RR) is low, and the blood pressure (BP) is high for the
age. For the typical adult, the temperature is high, the HR is low, the RR
is high, and the BP is elevated for the age. For the older adult, the
temperature is high-end normal, the HR is high, the RR is high, and the
BP is high for the age.
, ●● The nurse assesses the following changes in a clients vital signs.
Which client situation should be reported to the primary care provider?
1)Decreased blood pressure (BP) after standing up
2)Decreased temperature after a period of diaphoresis
3)Increased heart rate after walking down the hall
4)Increased respiratory rate when the heart rate increases
Answer: ANS: 1)Decreased blood pressure (BP) after standing up
A drop in the clients blood pressure when standing indicates orthostatic
hypotension, and the cause should be investigated. The changes in vital
signs indicated in the other options are normal changes for the situations.
PTS:1DIF:ModerateREF:p. 439 for hypotension information but should
read content about all of the vital signs
●● The clients temperature is 101.1F. Which is the correct conversion to
centigrade?
1)38.0C
2)38.4C
3)38.8C
4)39.2C
Answer: ANS: 2) 38.4C
