Questions With Solutions | Solved
A-D-P-I-E
A- assessment
D- Identify
P-Plan
I- Implement
E- Evaluate CORRECT ANSWERS how and why do nurses use vital signs?
-Admission to a health-care facility and home care visits
-hospital routine
-before,during,and after surgery, blood transfusion products, invasive diagnostic
procedures, medication administration
-Changes in the clients' condition or physical distress CORRECT ANSWERS when are
vital signs measured?
core CORRECT ANSWERS temperature within the deep tissue of the body are
constant. temperature stays the same. example: tympanic and rectal
surface CORRECT ANSWERS temperature changes based on blood flow to the skin
and amount of heat loss to the environment
. example: oral and skin
Thermoregulation CORRECT ANSWERS balance between heat loss and heat
production
set point CORRECT ANSWERS hypothalamus creates a comfortable temperature
know as the _______ if hot body will try to cool down
-Oral
-Rectal
-Axillary
-Tympanic membrane
-Temporal artery CORRECT ANSWERS what are the body temperature sites
98.6 F or 37 C CORRECT ANSWERS younger adult AVERAGE ORAL temperature
97.6 F to 99.6 F or 36.5 C to 37.5 C CORRECT ANSWERS young adult ORAL
temperature acceptable RANGE
95-97 F CORRECT ANSWERS ORAL older age body temperature RANGE
99.6 F or 37.5 C
, 1 F or 0.5 C higher than oral CORRECT ANSWERS normal RECTAL body temperature
97.6 F or 36.5
1 F or 0.5 C lower that oral CORRECT ANSWERS normal AXILLARY body temperature
-increase in white blood cells
-decreases iron in blood plasma(suppresses bacterial growth)
-increases production of interferon ( a virus fighting substance) CORRECT ANSWERS
beneficial consequences of fever
-increases BMR, P, R, dehydration, weight loss, and temperature
- seizures and neurological complications CORRECT ANSWERS harmful
consequences of fever
accessible, convenient CORRECT ANSWERS sites for assessing temperature orally
very accurate- reflects core CORRECT ANSWERS sites for assessing temperature
RECTAL
safest, goes under tongues of patient CORRECT ANSWERS sites for assessing
temperature AXILLA
accessible, fast,reflects core temperature, often imprecise
- thermometer goes ear CORRECT ANSWERS sites for assessing temperature
TYMPANIC MEMBRANE
fast, inconsistent reliability
-goes on forehead CORRECT ANSWERS sites for assessing temperature TEMPORAL
ARTERY
wait 30 minutes and take an oral temperature CORRECT ANSWERS the nurse has
delegated vital signs to the UAP( unlicensed Assistive Personnel). The UAP inform the
nurse that the patient has just finished a bowl of hot soup. what would be the best
response by the nurse?
tympanic membrane CORRECT ANSWERS a nurse is taking a patient's vital sign.
which route should the nurse choose to reflect a core temperature?
insert the thermometer 1/2 inches into rectum of an infant and 1 1/2 inches into adults
CORRECT ANSWERS A nurse is obtaining a rectal temperature with a patient. what
action by the nurse will insure an accurate measurement?
fever increases the basal metabolic rate CORRECT ANSWERS a nurse is teaching a
patient the adverse effects of a fever. which statement by the nurse is accurate?