Question 1

How should the nurse position the earpieces on a stethoscope to ensure optimum reception?

Accepted Answer

A) Backward 
B) Parallel to the ears 
C) Toward the face 
D) Downward 
A) Backward 
B) Parallel to the ears 
C) Toward the face 
D) Downward

Question 2

The nurse uses cooling techniques to keep the body temperature below 105° F.What can result from an elevated temperature?

Accepted Answer

A) Excessive thirst 
B) Excessive perspiration 
C) Damage to body cells 
D) Increased heart rate 
A) Excessive thirst 
B) Excessive perspiration 
C) Damage to body cells 
D) Increased heart rate

Question 3

What is the pulse-the expansion and contraction of an artery- produced by?

Accepted Answer

A) Contraction of the right atrium 
B) Contraction of the right ventricle 
C) Contraction of the left atrium 
D) Contraction of the left ventricle 
A) Contraction of the right atrium 
B) Contraction of the right ventricle 
C) Contraction of the left atrium 
D) Contraction of the left ventricle

Question 4

The physician orders daily weights on a patient residing in a long-term care setting.What actions should the nurse implement to assess weight accurately? (Select all that apply.)

Accepted Answer

A) Weigh patient at the same time each day 
B) Schedule weighing immediately after breakfast 
C) Encourage patient to void before being weighed 
D) Ensure same amount of clothing is worn by patient 
E) Calibrate by setting scale at zero after each weight 
A) Weigh patient at the same time each day 
B) Schedule weighing immediately after breakfast 
C) Encourage patient to void before being weighed 
D) Ensure same amount of clothing is worn by patient 
E) Calibrate by setting scale at zero after each weight

Question 5

A nurse assesses a patient's dorsalis pedis pulse.The pulse is not palpable when light pressure is applied.How should the nurse document this finding?

Accepted Answer

A) Weak pulse 
B) Normal pulse 
C) Thready pulse 
D) Bounding pulse 
A) Weak pulse 
B) Normal pulse 
C) Thready pulse 
D) Bounding pulse

Question 6

A nurse assesses a neonate's temperature by using a temporal artery scanner.What intervention should the nurse implement if the neonate's temperature is 99.5° F?

Accepted Answer

A) Record the findings 
B) Notify the physician 
C) Check the axillary temperature 
D) Check the tympanic temperature 
A) Record the findings 
B) Notify the physician 
C) Check the axillary temperature 
D) Check the tympanic temperature

Question 7

When assessing vital signs on a 40-year-old male,the nurse identifies a pulse rate of 120.What is this pulse interpreted as by the nurse?

Accepted Answer

A) Normal 
B) Bradycardic 
C) Arrhythmic 
D) Tachycardic 
A) Normal 
B) Bradycardic 
C) Arrhythmic 
D) Tachycardic

Question 8

A nurse assesses a patient's dorsalis pedis pulse.The pulse is easily felt but not palpable when moderate pressure is applied.How should the nurse document this finding?

Accepted Answer

A) Weak pulse 
B) Normal pulse 
C) Thready pulse 
D) Bounding pulse 
A) Weak pulse 
B) Normal pulse 
C) Thready pulse 
D) Bounding pulse

Question 9

The nurse is alarmed when a patient with a severe head injury of the occipital lobe has a respiratory rate of 10 breaths per minute.Where might this finding indicate that there is an injury?

Accepted Answer

A) Cerebellum 
B) Medulla oblongata 
C) Cortex 
D) Cerebrum 
A) Cerebellum 
B) Medulla oblongata 
C) Cortex 
D) Cerebrum

Question 10

When instructing a primary caregiver about keeping a daily log of blood pressure readings,what instructions should the nurse include? (Select all that apply.)

Accepted Answer

A) Take the reading at different times during the day. 
B) Apply the cuff approximately 2 inches above the antecubital fossa. 
C) If unable to get a reading the first time, immediately reinflate the cuff. 
D) Assess pulse with the bell of the stethoscope. 
E) Apply the cuff snugly. 
A) Take the reading at different times during the day. 
B) Apply the cuff approximately 2 inches above the antecubital fossa. 
C) If unable to get a reading the first time, immediately reinflate the cuff. 
D) Assess pulse with the bell of the stethoscope. 
E) Apply the cuff snugly.

Exam 11: Vital Signs

How should the nurse position the earpieces on a stethoscope to ensure optimum reception?

The nurse uses cooling techniques to keep the body temperature below 105° F.What can result from an elevated temperature?

What is the pulse-the expansion and contraction of an artery- produced by?

The physician orders daily weights on a patient residing in a long-term care setting.What actions should the nurse implement to assess weight accurately? (Select all that apply.)

A nurse assesses a patient's dorsalis pedis pulse.The pulse is not palpable when light pressure is applied.How should the nurse document this finding?

A nurse assesses a neonate's temperature by using a temporal artery scanner.What intervention should the nurse implement if the neonate's temperature is 99.5° F?

When assessing vital signs on a 40-year-old male,the nurse identifies a pulse rate of 120.What is this pulse interpreted as by the nurse?

A nurse assesses a patient's dorsalis pedis pulse.The pulse is easily felt but not palpable when moderate pressure is applied.How should the nurse document this finding?

The nurse is alarmed when a patient with a severe head injury of the occipital lobe has a respiratory rate of 10 breaths per minute.Where might this finding indicate that there is an injury?

When instructing a primary caregiver about keeping a daily log of blood pressure readings,what instructions should the nurse include? (Select all that apply.)

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