ATI RN
Chapter 12 Vital Signs Assessment Questions
Question 1 of 5
The normal temperature for an adult is:
Correct Answer: B
Rationale: 37 degrees Celsius (oral), is correct as it equals 98.6°F, the standard adult oral temperature. Axillary ( 37°C) is higher than typical (~36.6°C). 36°C oral, is too low (96.8°F). 37.7°C oral (99.9°F), suggests fever. Oral readings, taken sublingually, are 0.5°C below rectal (37.5°C-38.1°C) and 0.5°C above axillary (36.5°C-37°C), balancing accuracy and convenience. This norm, established by Wunderlich in the 19th century, remains a clinical benchmark, varying slightly by time of day or individual. Nursing relies on 37°C oral for baseline health, making B the accurate choice per physiological standards.
Question 2 of 5
A patient is experiencing pyrexia. Which piece of equipment will the nurse obtain to monitor this condition?
Correct Answer: B
Rationale: Pyrexia (fever) requires temperature monitoring, making a thermometer essential. A stethoscope assesses heart/lung sounds, not temperature. A blood pressure cuff or sphygmomanometer measures pressure, not fever. Choice B is correct as thermometers directly track temperature changes, a fundamental tool in nursing to manage and document febrile states accurately.
Question 3 of 5
The nurse is caring for a patient who reports feeling light-headed and 'woozy.' The nurse checks the patient's pulse and finds that it is irregular. The patient's blood pressure is 100/72. It was 113/80 an hour earlier. What should the nurse do?
Correct Answer: B
Rationale: Light-headedness, irregular pulse, and a BP drop (100/72 from 113/80) suggest instability (e.g., arrhythmia). Notifying the provider ensures prompt evaluation. More pressure won't clarify irregularity. Dismissing symptoms or delaying risks deterioration. Choice B is correct, per nursing escalation protocols.
Question 4 of 5
The five primary vital signs routinely monitored by both caregivers and medical professionals and highlighted in this training, include the following:
Correct Answer: D
Rationale: The five primary vital signs are body temperature, blood pressure, heart rate (pulse), respiratory rate, and oxygen saturation . Weight and height/BMI (B, C) are additional metrics, not core vital signs. Choice D is correct, listing the standard set monitored in clinical practice, per nursing and medical guidelines (e.g., WHO, ANA), essential for comprehensive patient assessment and detecting acute changes.
Question 5 of 5
You observe a nursing student taking a blood pressure (BP) on a patient. The patient's BP range over the past 24 hours is 132/64 to 126/72 mm Hg. The student used a BP cuff that was too narrow for the patient. Which of the following BP readings made by the student is most likely caused by the incorrect choice of BP cuff?
Correct Answer: D
Rationale: A too-narrow cuff overestimates BP. Past range (126/72–132/64) suggests 156/82 as falsely high, consistent with cuff error. 96/40 and 110/66 are too low. 130/70 fits prior range. Choice D is correct, per nursing principles on cuff size impacting accuracy, a common student mistake.