NUR 134 Vital signs ACTUAL UPDATED Exam Questions and CORRECT Answers

NUR 134 Vital signs ACTUAL UPDATED
Exam Questions and CORRECT Answers
Vital Signs include - CORRECT ANSWER Temperature, pulse, respiration, blood
pressure, pain, and o2 sat


When to measure vital signs - CORRECT ANSWER - admission
- institute policies
- change in pt's condition
- loss of consciousness
- pre op and post op
- before and after certain activities (ex: therapy)
- before and after meds that can affect VS


Nursing interventions for abnormal VS - CORRECT ANSWER abnormal vs --> double
check VS --> compare to prev findings --> further assess the pt --> interpret VS --> report


Normal body temperature range - CORRECT ANSWER 96.4 degrees - 99.5 degrees
Fahrenheit


Oral temperature - CORRECT ANSWER 98.6



Rectal temperature - CORRECT ANSWER 99.5



Axillary temperature - CORRECT ANSWER 97.7



Tympanic temperature - CORRECT ANSWER 99.5

, Temporal Artery temperature - CORRECT ANSWER 98.5



Heat Production - CORRECT ANSWER Metabolism is the primary source (hormones,
muscles movements, exercise).


Hormones (epinephrine and norepinephrine)


Skeletal muscle activity (exercise, shivering, piloerection)


Vasoconstriction


Heat loss - CORRECT ANSWER Skin is the primary source through sweating and
elimination.


Too hot - how will your body respond? - CORRECT ANSWER Sweating, decreased
metabolic rate, vasodilation


Too cold - how will your body respond? - CORRECT ANSWER Shivering,
vasoconstriction, piloerection, increase metabolism


Factors affecting body temperature - CORRECT ANSWER - age and gender
- circadian rhythm
- exercise
- endocrine
- environment


Fever (pyrexia) - CORRECT ANSWER Heat loss mechanisms unable to keep pace with
excess heat production. Fever of greater than or equal to 106 is referred to as hyperpyrexia. This
is a medical emergency.