Chapter 17: Vital Signs - Nurselytic

Questions 8

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Fundamentals of Nursing Care: Concepts, Connections & Skills

Chapter 17 : Vital Signs Questions

Question 1 of 5

You must assess the temperature of an 89-year-old female who is confused, hostile, and combative. Which route would be most appropriate to use?

Correct Answer: C

Rationale: Temporal route is non-invasive, safe, and accurate for confused or combative patients.

Question 2 of 5

Upon assessing the vital signs of a 56-year-old male, you find that he has an apical pulse of 71 bpm and a radial pulse of 62 bpm. Which of the following numbers would be correct to document as the pulse deficit?

Correct Answer: D

Rationale: Pulse deficit is the difference between apical (71) and radial (62) pulses, which is 9.

Question 3 of 5

A 68-year-old African American female is admitted for hypertension. She is at risk for hypertension based on which of the following?

Correct Answer: A,B,D

Rationale: Smoking, obesity, and alcohol consumption are modifiable risk factors for hypertension.

Question 4 of 5

The nurse would refrain from taking a BP on which of the following areas?

Correct Answer: A,B,C,D

Rationale: BP measurement is contraindicated in areas with amputation, mastectomy, IV infusion, or shunts to avoid injury or inaccurate readings.

Question 5 of 5

The disadvantages of the oral and skin temperatures assessment routes for an adult patient include which of the following?

Correct Answer: A,B,D

Rationale: Oral and skin routes risk fluid exposure, are affected by environmental temperatures, and are unsuitable for confused or unconscious patients.

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