BSN 206 - Vital Signs post tests
and exam|58 Q’s and A’s
Which of the following patients would require follow-up? - -An adult with a
respiratory rate of 10 breaths per minute.
- Which of the following vital signs recorded for an older adult would be
considered acceptable (within normal limits)? - -Temp 97.0° F (36.1 °C), P-
60, R-16, BP 116/78, O2 sat 95%
- The nurse has delegated the task of temperature assessment to the NAP.
Which information should be provided to the NAP? - -What changes to report
immediately to the nurse.
The frequency for taking or monitoring the temperature.
The type of temperature required.
- Which of the following situations may affect a patient's vital signs? - -
Moving from lying to standing position.
Pain rated as a 7 on 0-10 pain scale.
Time of day.
- The nurse will take the patient's vital signs preoperatively and record them
as part of the patient's preparation for surgery. Why is it necessary to take
vital signs preoperatively? - -To verify the patient is not experiencing any
complications that may contraindicate surgery or require intervention.
To provide a set of vital signs to use for comparison during and after surgery.
- The NAP reports to the nurse a 65-year-old patient s blood pressure is
160/98. What is the appropriate initial response of the nurse? - -Assess the
patient s blood pressure.
- Which patient would it be appropriate for the nurse to delegate vital signs -
-Elderly nursing home resident
- Which person would be expected to have the lowest body temperature - -
An 80-year-old who walked half a mile
80-year-old would have a lower starting temperature and therefore, would
most likely have the lowest body temperature although it may take longer to
return to baseline after exercise.
- The NAP is preparing to measure a patient's vital signs. The patient reports
having eaten a bowl of warm soup. The NAP asks the RN what he should do.
What is the best response - -Ask the patient not to eat, drink, or smoke for 20
minutes and then assess the patient's oral temperature.
, The temperature of food or liquid could impair the accuracy of the reading.
- For which patient would a tympanic thermometer be the preferred
thermometer to use - -A tachypneic patient who is receiving oxygen by nasal
cannula.
- Which of the following patients would require frequent assessment of their
temperature - -A young adult with a white blood count of 15,000/mm
A patient receiving a blood transfusion for chronic anemia.
An adult female in the recovery room following a hysterectomy.
- The NAP reports that the patient's temperature is 39° C (102.2 °F). Which
of the following are appropriate nursing actions? - -Remove the patient's
blankets
Administer an antipyretic to the patient as ordered.
- Which of the following actions, if made by the NAP, would require
intervention and further instruction by the nurse? - -The NAP wipes the
single-use chemical dot thermometer and places it back in the patient's
drawer for future use.
The NAP inserts the red-tipped electronic thermometer probe into the
patient's mouth after applying a probe cover.
- Identify the factors that may have an effect on an elderly patient's
temperature - -Drinking a cold glass of water.
Infection
Room temperature.
Participation in physical therapy exercises.
- If a 52-year-old patient has a normal temperature, what range should the
patient's temperature fall within - -96.8-100.4 °F (36-38 °C)
- A newborn patient's temperature has been rising rapidly and the baby has
been crying. Which of the following thermometers would be the best to use
in measuring this patient's temperature - -Temporal artery
- The task of pulse assessment could be delegated to the NAP for which of
the following patients - -A radial pulse on a patient with a 1200 mL fluid
restriction.
The temporal pulse of a child.
- Which of the following patients would be at risk for having an alteration in
peripheral pulse - -A patient with peripheral vascular disease.
A patient who is receiving bolus IV fluids.
The patient who was just informed of a diagnosis of cancer.
and exam|58 Q’s and A’s
Which of the following patients would require follow-up? - -An adult with a
respiratory rate of 10 breaths per minute.
- Which of the following vital signs recorded for an older adult would be
considered acceptable (within normal limits)? - -Temp 97.0° F (36.1 °C), P-
60, R-16, BP 116/78, O2 sat 95%
- The nurse has delegated the task of temperature assessment to the NAP.
Which information should be provided to the NAP? - -What changes to report
immediately to the nurse.
The frequency for taking or monitoring the temperature.
The type of temperature required.
- Which of the following situations may affect a patient's vital signs? - -
Moving from lying to standing position.
Pain rated as a 7 on 0-10 pain scale.
Time of day.
- The nurse will take the patient's vital signs preoperatively and record them
as part of the patient's preparation for surgery. Why is it necessary to take
vital signs preoperatively? - -To verify the patient is not experiencing any
complications that may contraindicate surgery or require intervention.
To provide a set of vital signs to use for comparison during and after surgery.
- The NAP reports to the nurse a 65-year-old patient s blood pressure is
160/98. What is the appropriate initial response of the nurse? - -Assess the
patient s blood pressure.
- Which patient would it be appropriate for the nurse to delegate vital signs -
-Elderly nursing home resident
- Which person would be expected to have the lowest body temperature - -
An 80-year-old who walked half a mile
80-year-old would have a lower starting temperature and therefore, would
most likely have the lowest body temperature although it may take longer to
return to baseline after exercise.
- The NAP is preparing to measure a patient's vital signs. The patient reports
having eaten a bowl of warm soup. The NAP asks the RN what he should do.
What is the best response - -Ask the patient not to eat, drink, or smoke for 20
minutes and then assess the patient's oral temperature.
, The temperature of food or liquid could impair the accuracy of the reading.
- For which patient would a tympanic thermometer be the preferred
thermometer to use - -A tachypneic patient who is receiving oxygen by nasal
cannula.
- Which of the following patients would require frequent assessment of their
temperature - -A young adult with a white blood count of 15,000/mm
A patient receiving a blood transfusion for chronic anemia.
An adult female in the recovery room following a hysterectomy.
- The NAP reports that the patient's temperature is 39° C (102.2 °F). Which
of the following are appropriate nursing actions? - -Remove the patient's
blankets
Administer an antipyretic to the patient as ordered.
- Which of the following actions, if made by the NAP, would require
intervention and further instruction by the nurse? - -The NAP wipes the
single-use chemical dot thermometer and places it back in the patient's
drawer for future use.
The NAP inserts the red-tipped electronic thermometer probe into the
patient's mouth after applying a probe cover.
- Identify the factors that may have an effect on an elderly patient's
temperature - -Drinking a cold glass of water.
Infection
Room temperature.
Participation in physical therapy exercises.
- If a 52-year-old patient has a normal temperature, what range should the
patient's temperature fall within - -96.8-100.4 °F (36-38 °C)
- A newborn patient's temperature has been rising rapidly and the baby has
been crying. Which of the following thermometers would be the best to use
in measuring this patient's temperature - -Temporal artery
- The task of pulse assessment could be delegated to the NAP for which of
the following patients - -A radial pulse on a patient with a 1200 mL fluid
restriction.
The temporal pulse of a child.
- Which of the following patients would be at risk for having an alteration in
peripheral pulse - -A patient with peripheral vascular disease.
A patient who is receiving bolus IV fluids.
The patient who was just informed of a diagnosis of cancer.
