ATI LPN
Foundations and Adult Health Nursing Test Bank
Chapter 12 : Vital Signs Questions
Question 1 of 5
When instructing a primary caregiver about keeping a daily log of blood pressure readings what instructions should the nurse include?
Correct Answer: B,E
Rationale: Readings for a blood pressure log should be taken at the same time every day on the same arm. The cuff should be applied 2 in above the antecubital fossa and snugly secured. The pulse should be assessed with the diaphragm of the stethoscope. If unable to get a reading the first time, the cuff should be deflated completely and reinflated after several minutes.
Question 2 of 5
When assessing factors that may influence the patient's pulse rate what should the nurse take into consideration?
Correct Answer: A,B,C,D
Rationale: All the options listed can affect the pulse rate, except religion.
Question 3 of 5
A patient is admitted to a medical surgical unit. What factors will determine how frequently vital signs will be assessed?
Correct Answer: B,D,E
Rationale: Whether and how frequently vital signs are measured depends on the nurse's judgment of need, orders of the health care provider, and patient's condition. Desire of the patient and family members cannot override these factors, but can be taken into consideration within reason of these factors.
Question 4 of 5
The home health nurse is preparing to educate a patient regarding electronic self-blood pressure measurement. What information should the nurse provide regarding this procedure?
Correct Answer: B,C,D
Rationale: Self-blood pressure monitoring requires proper measurement techniques, cuff is made to fit over clothing, and stethoscopes are not required. Values may be inaccurate and recalibration is necessary at least once a year.
Question 5 of 5
The health care provider orders daily weights on a patient residing in a long-term care setting. What actions should the nurse implement to assess weight accurately?
Correct Answer: A,C,D
Rationale: Accurate assessment of weight should occur at the same time each day, preferably at 6 a.m. before breakfast. The patient should be encouraged to void before being weighed and the same amount of clothing should be worn each day. The scale should be calibrated to zero before (not after) each weight is taken.