Prep U Chapter 25 Vital Signs Exam Questions And
Answers 100% Correct
A nurse is filling out an incident report after an older adult client fell while attempting to
transfer from her bed to a commode. Which health problem should the nurse consider
when client falls occur? - ANSWER orthostatic hypertension
associated with weakness or fainting when one rises to an erect position
When assessing an infant's axillary temperature, it will be: - ANSWER 1°F (0.5°C) lower
than an oral temperature.
An ultrasonic Doppler is used for: - ANSWER auscultating a pulse that is difficult to
palpate
A person's core body temperature is highest in the early morning and lowest in the late
afternoon. - ANSWER false
The nurse is preparing to assess a client's oral temperature. The nurse should plan to
place the thermometer probe in which area of the client's mouth? - ANSWER deep in the
posterior sublingual pocket
A nurse is assessing the respirations of a 60-year-old female client and finds that the
client's breaths are so shallow that the respirations cannot be counted. What would be
the appropriate initial nursing intervention in this situation? - ANSWER auscultate the
lung sounds and count respirations
The nurse is preparing to assess a rectal temperature on an adult client. What is the
appropriate nursing intervention? - ANSWER provide privacy for the client
The home care nurse notices that the client only has a glass thermometer. What is the
best response by the nurse? - ANSWER would you consider using a digital thermometer
The nurse is assessing a client's blood pressure and is having difficulty hearing
Korotkoff sounds. What is the most appropriate nursing action? - ANSWER ask the client
to make a fist after cuff inflation
A nurse is assessing an adult client's blood pressure. How should the nurse estimate the
client's systolic blood pressure (SBP)? - ANSWER Inflate the blood pressure cuff while
palpating the client's brachial artery.
Correct response:
The nurse places a client experiencing labored breathing in an upright position. The
, nurse notes that the client is able to breathe more easily in this upright position and
documents this condition on the chart as: - ANSWER orthopnea
A nurse is assessing an apical pulse on a cardiac client. The client is taking digoxin. The
nurse can anticipate that the digoxin will: - ANSWER decrease the apical pulse
A pulse deficit is the difference between: - ANSWER the apical pulse and the radial pulse
rate
A client has smoked most of his life and has labored respirations. He is experiencing: -
ANSWER dyspnea
The nurse is preparing to administer a medication that the client takes to treat a cardiac
dysrhythmia. Which site should the nurse use to assess pulse in this client? - ANSWER
apical
Which peripheral pulse site is generally used in emergency situations? - ANSWER
cartoid
A nurse is caring for an adult with fever. The nurse determines that which site is most
ideal for obtaining the client's core body temperature? - ANSWER rectum
A nurse is assessing an apical pulse on a cardiac client. The client is taking digoxin,
which is a cardiac medication. The nurse can anticipate that the digoxin will - ANSWER
decrease the apical pulse
A 62-year-old female client being treated for hypertension did not take her daily BP
medication over the weekend because she was out of medication and the pharmacy was
closed. Her average home blood pressure monitoring (HBPM) reading has been 130/82.
Today her BP has been 138/90, 135/85, and 142/86. She calls the on-call nurse for her
health care provider. What is the most appropriate thing for this nurse to advise this
client? - ANSWER To take the recommended daily dose of medication and call the health
care provider if the average of her HBPM readings increase/decrease by 10, or if she
has any other concerns.
A 70-year-old client is taking his own pulse at home. He is following the instructions
provided by the nurse. He counts his pulse 62 times in one minute. What should he do
next? - ANSWER write it down
The nurse is teaching the parents of an infant with an irregular heartbeat how to check
the pulse rate. The infant's pulse is very high and irregular. What will the nurse have to
do in order to teach these parents how to monitor their infant's pulse rate? - ANSWER
The parents will have to be taught how to use a stethoscope so that they can listen to
and count the infant's apical pulse.
Answers 100% Correct
A nurse is filling out an incident report after an older adult client fell while attempting to
transfer from her bed to a commode. Which health problem should the nurse consider
when client falls occur? - ANSWER orthostatic hypertension
associated with weakness or fainting when one rises to an erect position
When assessing an infant's axillary temperature, it will be: - ANSWER 1°F (0.5°C) lower
than an oral temperature.
An ultrasonic Doppler is used for: - ANSWER auscultating a pulse that is difficult to
palpate
A person's core body temperature is highest in the early morning and lowest in the late
afternoon. - ANSWER false
The nurse is preparing to assess a client's oral temperature. The nurse should plan to
place the thermometer probe in which area of the client's mouth? - ANSWER deep in the
posterior sublingual pocket
A nurse is assessing the respirations of a 60-year-old female client and finds that the
client's breaths are so shallow that the respirations cannot be counted. What would be
the appropriate initial nursing intervention in this situation? - ANSWER auscultate the
lung sounds and count respirations
The nurse is preparing to assess a rectal temperature on an adult client. What is the
appropriate nursing intervention? - ANSWER provide privacy for the client
The home care nurse notices that the client only has a glass thermometer. What is the
best response by the nurse? - ANSWER would you consider using a digital thermometer
The nurse is assessing a client's blood pressure and is having difficulty hearing
Korotkoff sounds. What is the most appropriate nursing action? - ANSWER ask the client
to make a fist after cuff inflation
A nurse is assessing an adult client's blood pressure. How should the nurse estimate the
client's systolic blood pressure (SBP)? - ANSWER Inflate the blood pressure cuff while
palpating the client's brachial artery.
Correct response:
The nurse places a client experiencing labored breathing in an upright position. The
, nurse notes that the client is able to breathe more easily in this upright position and
documents this condition on the chart as: - ANSWER orthopnea
A nurse is assessing an apical pulse on a cardiac client. The client is taking digoxin. The
nurse can anticipate that the digoxin will: - ANSWER decrease the apical pulse
A pulse deficit is the difference between: - ANSWER the apical pulse and the radial pulse
rate
A client has smoked most of his life and has labored respirations. He is experiencing: -
ANSWER dyspnea
The nurse is preparing to administer a medication that the client takes to treat a cardiac
dysrhythmia. Which site should the nurse use to assess pulse in this client? - ANSWER
apical
Which peripheral pulse site is generally used in emergency situations? - ANSWER
cartoid
A nurse is caring for an adult with fever. The nurse determines that which site is most
ideal for obtaining the client's core body temperature? - ANSWER rectum
A nurse is assessing an apical pulse on a cardiac client. The client is taking digoxin,
which is a cardiac medication. The nurse can anticipate that the digoxin will - ANSWER
decrease the apical pulse
A 62-year-old female client being treated for hypertension did not take her daily BP
medication over the weekend because she was out of medication and the pharmacy was
closed. Her average home blood pressure monitoring (HBPM) reading has been 130/82.
Today her BP has been 138/90, 135/85, and 142/86. She calls the on-call nurse for her
health care provider. What is the most appropriate thing for this nurse to advise this
client? - ANSWER To take the recommended daily dose of medication and call the health
care provider if the average of her HBPM readings increase/decrease by 10, or if she
has any other concerns.
A 70-year-old client is taking his own pulse at home. He is following the instructions
provided by the nurse. He counts his pulse 62 times in one minute. What should he do
next? - ANSWER write it down
The nurse is teaching the parents of an infant with an irregular heartbeat how to check
the pulse rate. The infant's pulse is very high and irregular. What will the nurse have to
do in order to teach these parents how to monitor their infant's pulse rate? - ANSWER
The parents will have to be taught how to use a stethoscope so that they can listen to
and count the infant's apical pulse.
