Exam 3: Vital Signs

A 2-month-old infant has a temperature of 104.2°F axillary. Which route should the nurse use to validate this measurement?

Which adult vital signs would the nurse need to report immediately?

The nurse assesses vital signs on four clients. Which client would be the first priority for the nurse to assess based on the vital signs?

The nurse is caring for a client who is experiencing acute hemorrhagic shock. The client's blood pressure is 60/28 mmHg. How will the nurse assess this client's pulse?

The nurse is reviewing tasks to assign to unlicensed assistive personnel (UAP). Which task should the nurse complete?

The clinic nurse measures the client's blood pressure and obtains a reading of 144/82 mmHg. The client's baseline blood pressure has been normal. For what factors would the nurse assess the client based on the current blood pressure reading? Select all that apply.

The nurse is caring for a client with vital signs 97.2°F; 112; 48; 104/86 mmHg; and oxygen saturation is 76%. Place the nursing actions in order of their priority for this client. Response 1. Assess the client. Response 2. Reduce client anxiety. Response 3. Notify the health care provider. Response 4. Obtain assistance from another nurse or member of the team. Response 5. Administer oxygen.

The nurse is admitting a client who plays professional football. The nurse assesses vital signs and records the following measurements: 98.6°F; 48; 10; 88/54 mmHg. The client says he "feels fine" and denies any symptoms. Which action by the nurse is the priority?