RN Vital Signs Assessment 2.0
Questions and Answers | Latest Version
| 2025/2026 | Correct & Verified
Which of the following factors can falsely elevate a client’s oral temperature?
A. Drinking ice water
✔✔B. Smoking a cigarette
C. Taking a cold shower
D. Resting in a cool room
Which pulse site is most appropriate to assess during cardiopulmonary resuscitation (CPR)?
✔✔A. Carotid
B. Brachial
C. Radial
D. Temporal
What should the nurse do if the client's blood pressure reading is 88/56 mmHg and they are
dizzy?
A. Reassess in 15 minutes
1
,✔✔B. Lay the client down and notify the provider
C. Offer fluids and recheck in an hour
D. Document and proceed with routine care
Which action ensures the most accurate respiratory rate assessment?
✔✔A. Observe chest movement while pretending to check the pulse
B. Ask the patient to breathe deeply while counting
C. Place a hand on the chest and count aloud
D. Watch the client closely and ask them to count their breaths
Which reading is considered within the normal range for an adult’s oral temperature?
A. 36.0°C (96.8°F)
✔✔B. 37.0°C (98.6°F)
C. 38.5°C (101.3°F)
D. 35.5°C (95.9°F)
What should the nurse do if a client’s pulse oximeter reads 85%?
A. Remove the sensor and try again later
2
,✔✔B. Reposition the sensor and assess the patient immediately
C. Ignore the reading if the patient looks well
D. Tell the client to take deep breaths and reassess in the morning
Which of the following situations requires the nurse to take an apical pulse?
A. The client is sleeping
B. The client has a low oxygen saturation
✔✔C. The client is on a cardiac medication like digoxin
D. The client has just eaten
A blood pressure cuff that is too small for the arm may result in:
A. A false low reading
✔✔B. A false high reading
C. No reading at all
D. Consistent and accurate results
Which of the following indicates orthostatic hypotension?
✔✔A. A drop in systolic BP of 20 mmHg upon standing
3
, B. An increase in pulse of 10 bpm when sitting
C. A respiratory rate increase when lying down
D. A normal blood pressure that changes with anxiety
Which pain scale is most appropriate for a 4-year-old child?
A. Numeric Rating Scale
B. Visual Analog Scale
✔✔C. Wong-Baker FACES Scale
D. FLACC Behavioral Scale
Which location provides the most reliable core temperature reading in adults?
A. Axillary
✔✔B. Rectal
C. Tympanic
D. Oral
When should a nurse avoid using the oral temperature method?
✔✔A. After the patient drank a hot beverage
4
Questions and Answers | Latest Version
| 2025/2026 | Correct & Verified
Which of the following factors can falsely elevate a client’s oral temperature?
A. Drinking ice water
✔✔B. Smoking a cigarette
C. Taking a cold shower
D. Resting in a cool room
Which pulse site is most appropriate to assess during cardiopulmonary resuscitation (CPR)?
✔✔A. Carotid
B. Brachial
C. Radial
D. Temporal
What should the nurse do if the client's blood pressure reading is 88/56 mmHg and they are
dizzy?
A. Reassess in 15 minutes
1
,✔✔B. Lay the client down and notify the provider
C. Offer fluids and recheck in an hour
D. Document and proceed with routine care
Which action ensures the most accurate respiratory rate assessment?
✔✔A. Observe chest movement while pretending to check the pulse
B. Ask the patient to breathe deeply while counting
C. Place a hand on the chest and count aloud
D. Watch the client closely and ask them to count their breaths
Which reading is considered within the normal range for an adult’s oral temperature?
A. 36.0°C (96.8°F)
✔✔B. 37.0°C (98.6°F)
C. 38.5°C (101.3°F)
D. 35.5°C (95.9°F)
What should the nurse do if a client’s pulse oximeter reads 85%?
A. Remove the sensor and try again later
2
,✔✔B. Reposition the sensor and assess the patient immediately
C. Ignore the reading if the patient looks well
D. Tell the client to take deep breaths and reassess in the morning
Which of the following situations requires the nurse to take an apical pulse?
A. The client is sleeping
B. The client has a low oxygen saturation
✔✔C. The client is on a cardiac medication like digoxin
D. The client has just eaten
A blood pressure cuff that is too small for the arm may result in:
A. A false low reading
✔✔B. A false high reading
C. No reading at all
D. Consistent and accurate results
Which of the following indicates orthostatic hypotension?
✔✔A. A drop in systolic BP of 20 mmHg upon standing
3
, B. An increase in pulse of 10 bpm when sitting
C. A respiratory rate increase when lying down
D. A normal blood pressure that changes with anxiety
Which pain scale is most appropriate for a 4-year-old child?
A. Numeric Rating Scale
B. Visual Analog Scale
✔✔C. Wong-Baker FACES Scale
D. FLACC Behavioral Scale
Which location provides the most reliable core temperature reading in adults?
A. Axillary
✔✔B. Rectal
C. Tympanic
D. Oral
When should a nurse avoid using the oral temperature method?
✔✔A. After the patient drank a hot beverage
4
