Nurs 323 Exam UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
What vital signs do we take? - CORRECT ANSWER BP, RR, HR, T, O2 sat (pain)
Why do we take vital signs? - CORRECT ANSWER Measures system functioning
When should we take vital signs? - CORRECT ANSWER When patient is showing symptoms
something is wrong, after interventions are given, if a vital sign is abnormal retake. Schedule by
clinical judgement.
Normal heart rate for adults - CORRECT ANSWER 60-100 bpm
<60 bpm is bradycardia
>100 bpm is tachycardia
Normal BP for adults? - CORRECT ANSWER 120/80
<90/60 hypotension
>130/90 hypertensive
Normal RR for adults? - CORRECT ANSWER 12-20 breaths per minute
<10 hypoventilation
>20 hyperventilation
Normal O2 saturation for adults - CORRECT ANSWER 95-100%
<95%=hypoxemia
(at higher elevations 90-95% is normal)
Normal temperature - CORRECT ANSWER 98.6-100.4 degrees Fahrenheit
<97.8 hypothermia
,>100.4 febrile temperature
What does vasoconstriction cause in relation to temperature? - CORRECT ANSWER shivering
What can vasodilation cause in relation to temperature? - CORRECT ANSWER radiation,
convection, sweating
What methods can we use to take temperature? - CORRECT ANSWER Oral, rectal, skin,
temporal artery, axillary, tympanic, indwelling devices
What factors can impact temperature? - CORRECT ANSWER Circadian rhythm, age, activity,
hormones, stress, environment, sensation
An increase in temperature by 1 degree increases metabolism by ____% - CORRECT ANSWER
1%
Symptoms of heat exhaustion - CORRECT ANSWER hot, diaphoretic skin
Symptoms of heat stroke - CORRECT ANSWER hot dry skin, hypotension
hypothermia levels - CORRECT ANSWER mild (32-35C)
moderate (28-32C)
Severe (<28C)
When should I take cultures with a fever? - CORRECT ANSWER BEFORE antibiotics
As a nurse what can we do for fevers? - CORRECT ANSWER cultures, oxygen, fluids,
nutrition, maximize heat loss. antipyretics
As a nurse what can we do for heatstroke/exhaustion? - CORRECT ANSWER cardiovascular
support, rapid cooling
, As a nurse what can we do for hypothermia? - CORRECT ANSWER remove wet clothing, hot
liquid intake (avoid alcohol)
What arteries can we use to find pulse? - CORRECT ANSWER Carotid, brachial, femoral,
popliteal, posterior tibial, dorsalis pedis
How long do we listen for apical pulses? - CORRECT ANSWER a FULL MINUTE
How long do you count for IRREGULAR pulses? - CORRECT ANSWER A FULL minute
Where do we listen for apical pulse? - CORRECT ANSWER 5th intercostal space (between
5th and 6th rib) midclavicular (lub dub=one beat)
What can cause bradypnea? - CORRECT ANSWER narcotics, carbon monoxide, etc.
What can cause tachypnea? - CORRECT ANSWER asthma, anxiety, pain, infection
What is measured with an SpO2? - CORRECT ANSWER diffusion and perfusion
What can influence our respiration? - CORRECT ANSWER Exercise, pain, anxiety,
positioning, medications, near injury
What is the formula for calculating cardiac output? - CORRECT ANSWER stroke volume x
rate = cardiac output
What influences our blood pressure? - CORRECT ANSWER age, stress, ethnicity, gender,
circadian rhythm, medication, activity/weight, smoking
What is the silent killer? - CORRECT ANSWER hypertension
If the blood pressure cuff is too small what happens? - CORRECT ANSWER You can get a
false high blood pressure reading
QUESTIONS AND CORRECT ANSWERS
What vital signs do we take? - CORRECT ANSWER BP, RR, HR, T, O2 sat (pain)
Why do we take vital signs? - CORRECT ANSWER Measures system functioning
When should we take vital signs? - CORRECT ANSWER When patient is showing symptoms
something is wrong, after interventions are given, if a vital sign is abnormal retake. Schedule by
clinical judgement.
Normal heart rate for adults - CORRECT ANSWER 60-100 bpm
<60 bpm is bradycardia
>100 bpm is tachycardia
Normal BP for adults? - CORRECT ANSWER 120/80
<90/60 hypotension
>130/90 hypertensive
Normal RR for adults? - CORRECT ANSWER 12-20 breaths per minute
<10 hypoventilation
>20 hyperventilation
Normal O2 saturation for adults - CORRECT ANSWER 95-100%
<95%=hypoxemia
(at higher elevations 90-95% is normal)
Normal temperature - CORRECT ANSWER 98.6-100.4 degrees Fahrenheit
<97.8 hypothermia
,>100.4 febrile temperature
What does vasoconstriction cause in relation to temperature? - CORRECT ANSWER shivering
What can vasodilation cause in relation to temperature? - CORRECT ANSWER radiation,
convection, sweating
What methods can we use to take temperature? - CORRECT ANSWER Oral, rectal, skin,
temporal artery, axillary, tympanic, indwelling devices
What factors can impact temperature? - CORRECT ANSWER Circadian rhythm, age, activity,
hormones, stress, environment, sensation
An increase in temperature by 1 degree increases metabolism by ____% - CORRECT ANSWER
1%
Symptoms of heat exhaustion - CORRECT ANSWER hot, diaphoretic skin
Symptoms of heat stroke - CORRECT ANSWER hot dry skin, hypotension
hypothermia levels - CORRECT ANSWER mild (32-35C)
moderate (28-32C)
Severe (<28C)
When should I take cultures with a fever? - CORRECT ANSWER BEFORE antibiotics
As a nurse what can we do for fevers? - CORRECT ANSWER cultures, oxygen, fluids,
nutrition, maximize heat loss. antipyretics
As a nurse what can we do for heatstroke/exhaustion? - CORRECT ANSWER cardiovascular
support, rapid cooling
, As a nurse what can we do for hypothermia? - CORRECT ANSWER remove wet clothing, hot
liquid intake (avoid alcohol)
What arteries can we use to find pulse? - CORRECT ANSWER Carotid, brachial, femoral,
popliteal, posterior tibial, dorsalis pedis
How long do we listen for apical pulses? - CORRECT ANSWER a FULL MINUTE
How long do you count for IRREGULAR pulses? - CORRECT ANSWER A FULL minute
Where do we listen for apical pulse? - CORRECT ANSWER 5th intercostal space (between
5th and 6th rib) midclavicular (lub dub=one beat)
What can cause bradypnea? - CORRECT ANSWER narcotics, carbon monoxide, etc.
What can cause tachypnea? - CORRECT ANSWER asthma, anxiety, pain, infection
What is measured with an SpO2? - CORRECT ANSWER diffusion and perfusion
What can influence our respiration? - CORRECT ANSWER Exercise, pain, anxiety,
positioning, medications, near injury
What is the formula for calculating cardiac output? - CORRECT ANSWER stroke volume x
rate = cardiac output
What influences our blood pressure? - CORRECT ANSWER age, stress, ethnicity, gender,
circadian rhythm, medication, activity/weight, smoking
What is the silent killer? - CORRECT ANSWER hypertension
If the blood pressure cuff is too small what happens? - CORRECT ANSWER You can get a
false high blood pressure reading
