Accurate Answers
define temperature: - ✔✔difference between heat produced & heat lost
define pulse: - ✔✔palpable bounding of blood flow
_______ represents the minimum amount of pressure exerted on the arteries - ✔✔diastolic
pressure
core temperature measurement sites (6) - ✔✔- rectum
- tympanic membrane
- temporal artery
- pulmonary artery
- esophagus
- urinary bladder
acceptable oral temperature range of an adult: - ✔✔36 to 38 ºC (96.8 to 100.4 ºF)
_______ temperatures are usually 0.5 ºC higher than oral and tympanic temperatures -
✔✔rectal
where should an oral probe be placed? - ✔✔posterior sublingual pocket
use this temperature site ______ for clients who are 4 years of age or older - ✔✔oral
how far should an anal probe be inserted? - ✔✔1 to 1.5 inches (for an adult)
,safety measures to consider when taking temperature rectally (3): - ✔✔- do not use for patients
with diarrhea
- do not use for patients on bleeding precautions
- do not use for patients with rectal disorders
a ______ measurement of temperature is generally most accurate - ✔✔rectal
physical process of measuring tympanic temperature in an adult: - ✔✔pull the ear up and back
physical process of measuring tympanic temperature in a child younger than 3: - ✔✔pull the
ear down and back
fever is usually not harmful unless it exceeds ______ - ✔✔102.2 ºF (39 ºC)
how would you manage fever in adults? - ✔✔provide antipyretics (aspirin, acetaminophen,
ibuprofen)
how should fever NOT be managed in children and adolescents with viral illness? why? - ✔✔do
not give aspirin; risk of Reye syndrome
hypothermia is a body temperature less than________ - ✔✔35ºC (95.2 ºF)
define pulse deficit: - ✔✔difference between the apical and radial pulse rates
what is the procedure for irregular pulsation? - ✔✔count for a full minute and compare the
result to the apical pulse rate
, when would you use the apical pulse site (4)? - ✔✔when assessing:
- infants
- rapid rates (faster than 100/min)
- irregular rhythms
- prior to the administration of cardiac medications
proper stethoscope placement: - ✔✔fifth intercostal space at the left midclavicular line
accurate assessment of respiration involves observing 3 things: - ✔✔- rate
- depth
- rhythm
respiration: the expected reference range for adults (per ATI) - ✔✔12 to 20 breaths/min
pulse oximetry: the expected reference range - ✔✔95% to 100%
respiration: the expected reference range for adolescents (per ATI) - ✔✔20 to 30 breaths/min
(general) procedure for measuring respiratory rate: - ✔✔- *observe one full respiratory cycle*
- if regular, count for 30 seconds & multiply by 2; if irregular, count for 1 min
BP: when should a patient return for two or more visits? - ✔✔if they have a SBP greater than
140 mm Hg & a DBP greater than 90 mm Hg (that are averages of two or more BP
measurements)
define pulse pressure: - ✔✔the difference between systolic & diastolic pressure readings