Seidel’s Guide to Physical Examination, 9th Edition (Chapter 06)

Chapter 06: Vital Signs and Pain Assessment
Ball: Seidel’s Guide to Physical Examination, 9th Edition


MULTIPLE CHOICE

1. The pyrexia response is triggered by the production and release of:
a. prostaglandins.
b. endogenous pyrogens.
c. hypothalamic enzymes.
d. thyroid hormones.
ANS: A
When microorganisms invade the body, pyrogens are released and travel to the hypothalamus.
The pyrexia response is then
triggered by the production and release of prostaglandins.

DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

2. During expiration, the internal intercostals:
a. increase the force of muscular contraction.
b. decrease the lateral diameter during expiration.
c. decrease the intrathoracic space.
d. increase elastic recoil during expiration.
ANS: B
The diaphragm is the dominant muscle during respiration. It contracts and pushes downward
during inspiration to increase the
intrathoracic space. The external intercostal muscles increase the AP diameter during inspiration
and the internal intercostals
decrease the lateral diameter during expiration.

DIF: Cognitive Level: Understanding (Comprehension)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

3. The fifth vital sign is:
a. pain.
b. orientation.
c. waist-to-hip ratio.
d. body mass index (BMI).
ANS: A
Pain, the universal distress signal, is now recognized as the fifth vital sign.

DIF: Cognitive Level: Remembering (Knowledge)
OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation

4. The Joint Commission (TJC) requires that:
a. pain be assessed on all discharges.