NUR 218
NUR218 Exam 1 Questions and Answers
trending vitals - over time part of the vitals are changing
ex. heart rate trending VP. helps to see if they're doing better or worse
vital signs - physical signs that indicate an individual is alive
normal vital signs change with - sex, weight, exercise, tolerance, and condition
your job as a nurse with vital signs is to what - MEASURE vital signs correctly,
UNDERSTAND and INTERPRET values, COMMUNICATE findings appropriately and
begin INTERVENTIONS as needed
good deviation - HR is 150, do intervention to bring that down
bad deviation - safe surgery, everything fine then they get fever. this is bad
baseline is used to identify what - changes in patient status
how do you establish trends - use the baseline and take a series of vital sign
measurements to get a patient trends
frequency - depend on patient status and clinical judgement
can you take vitals at any time - yes
NUR 218
,NUR 218
how often do you check vitals for a med surg patient - 4-8 hours
how often do you check vitals for a post surgery patient - every 15 minutes
how often do you check vitals for a critical patient - every 5 minutes
interpretation of vitals - compare patients results with normal values
what is temperature usually measured in - Celsius or Fahrenheit
what is the average temperature range - 97.6-99.6
average is 98.6
what is hyperthermia - over 104F
febrile - greater than 100.4F
why does the body enact a fever - its the bodys defense to destroy invading bacteria
hypothermia - less than 95F
common ways to measure temp - oral, axillary, tympanic, temporal, rectal
what is the most common way to measure temperature - oral (mouth)
what is the least accurate way to measure temp - axillary (armpit)
NUR 218
,NUR 218
what way to measure temp is most utilized in kids - tympanic (ear)
what do you need to do when taking temperature tympanically - for kids you pull the ear
down a little but for adults you hold up
temporal way to measure temp - forehead
what is the last resort in newborns but most accurate - rectal (anus)
what are the advanced ways to take temperature (usually for critical care patients) - foley
catheter and esopogeal)
how long do you wait to take temp after exercise or bath - at least 1 hour
how long do you wait to take temp after smoking or hot/cold foods - 30 minutes
T or F baseline oral temperature changes with age - TRUE. it tends to decrease slightly
with age
abbreviations for heart rate - P, HR, BPM
what is normal heart rate - 60-100bpm
T or F pulse fluctuates with exercise, illness, injury and/or emotions - TRUE
NUR 218
, NUR 218
T or F females have a higher HR than males - TRUE
bradycardia - less than 60bpm
what causes bradycardia and what are some signs - resting, heart block, dizziness, pale,
tired all the time
tachycardia - over 100bpm
what may cause tachycardia - Shock, hemorrhage, fever, acute pain, drugs, heart
palpatation
sites for assessing pulses - carotid (neck), brachial, radial, dorsalis pedis (feet), apical and
posterior tibial (ankle)
when is carotid used to assess pulse - emergency situations
located in neck
when is brachial used to assess pulse - blood pressure
what is the most common site to take a pulse - radial
what is important to know about taking pulse apically - you have to use a stethoscope and
be right over the heart
T or F you can use your thumb when taking a pulse - FALSE
NUR 218
NUR218 Exam 1 Questions and Answers
trending vitals - over time part of the vitals are changing
ex. heart rate trending VP. helps to see if they're doing better or worse
vital signs - physical signs that indicate an individual is alive
normal vital signs change with - sex, weight, exercise, tolerance, and condition
your job as a nurse with vital signs is to what - MEASURE vital signs correctly,
UNDERSTAND and INTERPRET values, COMMUNICATE findings appropriately and
begin INTERVENTIONS as needed
good deviation - HR is 150, do intervention to bring that down
bad deviation - safe surgery, everything fine then they get fever. this is bad
baseline is used to identify what - changes in patient status
how do you establish trends - use the baseline and take a series of vital sign
measurements to get a patient trends
frequency - depend on patient status and clinical judgement
can you take vitals at any time - yes
NUR 218
,NUR 218
how often do you check vitals for a med surg patient - 4-8 hours
how often do you check vitals for a post surgery patient - every 15 minutes
how often do you check vitals for a critical patient - every 5 minutes
interpretation of vitals - compare patients results with normal values
what is temperature usually measured in - Celsius or Fahrenheit
what is the average temperature range - 97.6-99.6
average is 98.6
what is hyperthermia - over 104F
febrile - greater than 100.4F
why does the body enact a fever - its the bodys defense to destroy invading bacteria
hypothermia - less than 95F
common ways to measure temp - oral, axillary, tympanic, temporal, rectal
what is the most common way to measure temperature - oral (mouth)
what is the least accurate way to measure temp - axillary (armpit)
NUR 218
,NUR 218
what way to measure temp is most utilized in kids - tympanic (ear)
what do you need to do when taking temperature tympanically - for kids you pull the ear
down a little but for adults you hold up
temporal way to measure temp - forehead
what is the last resort in newborns but most accurate - rectal (anus)
what are the advanced ways to take temperature (usually for critical care patients) - foley
catheter and esopogeal)
how long do you wait to take temp after exercise or bath - at least 1 hour
how long do you wait to take temp after smoking or hot/cold foods - 30 minutes
T or F baseline oral temperature changes with age - TRUE. it tends to decrease slightly
with age
abbreviations for heart rate - P, HR, BPM
what is normal heart rate - 60-100bpm
T or F pulse fluctuates with exercise, illness, injury and/or emotions - TRUE
NUR 218
, NUR 218
T or F females have a higher HR than males - TRUE
bradycardia - less than 60bpm
what causes bradycardia and what are some signs - resting, heart block, dizziness, pale,
tired all the time
tachycardia - over 100bpm
what may cause tachycardia - Shock, hemorrhage, fever, acute pain, drugs, heart
palpatation
sites for assessing pulses - carotid (neck), brachial, radial, dorsalis pedis (feet), apical and
posterior tibial (ankle)
when is carotid used to assess pulse - emergency situations
located in neck
when is brachial used to assess pulse - blood pressure
what is the most common site to take a pulse - radial
what is important to know about taking pulse apically - you have to use a stethoscope and
be right over the heart
T or F you can use your thumb when taking a pulse - FALSE
NUR 218
