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Adult Vital Signs (VS)

Adult Vital Signs (VS)

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10 Adult Vital Signs (VS) NCLEX Questions

Question 1 of 10

A nurses receives report on several clients. The nurse knows to be most concerned about hyperthermia with which of the following client temperatures?

94.1F

104.2F

100F

98.9F

Question 2 of 10

The nurse just received reports on the following four clients Which client should the nurse see first? 1) A 54-year-old with a blood pressure of 140/90 mmHg 2) An 89-year-old with a heart rate of 110 3) A 40-year-old with a respiration rate of 30 breaths per minute 4) A 91-year-old who needs to use the bathroom.

91-year-old who needs to use the bathroom

89-year-old male with a heart rate of 110

54-year-old with a blood pressure of 140/90 mmHg

40-year-old with a respiration rate of 30 breaths per minute

Question 3 of 10

A client came in with a temperature of 105F. On assessment the nurse notes the client to be confused. The client is hot to the touch but not sweaty and has a weak pulse. The nurse should implement which of the following precaution types for this client?

Droplet

Neutropenic

Seizure

Contact

Question 4 of 10

A client is being assessed and has a temperature of 104.2F. Which of the following actions should the nurse take first?

Educate the client on staying cool in the heat

Call the healthcare provider

Give morphine

Place cool wet towels on client

Question 5 of 10

The nurse is caring for a client who arrives at the emergency department after falling down multiple times. Upon initial assessment, the client states, “I am so dizzy I can’t stay standing up.” What is the nurse’s first priority?

Full neurological exam

Draw blood

Vital Signs

Get an EKG (ECG)

Question 6 of 10

A client was found lying outside in the snow unconscious and brought to the emergency room. Upon assessment, the nurse finds that the client has a temperature of 92.1 F and the nurse is unable to palpate the left radial pulse. The nurse should do which of the following first?

Get the warming device and place over client’s body

Use doppler to find pulse

Educate the client on the importance of keeping warm

Give the client a warm drink

Question 7 of 10

The nurse receives report on a client with active chest pain and a type B aortic dissection noted on CT. The client has an arterial line placed. Which is the most important vital sign to monitor?

Respirations

Blood pressure

Temperature

Heart rate

Question 8 of 10

A nurse is utilizing the PQRST pain assessment method to determine if a client is experiencing pain. Which questions would the nurse ask according to the P portion of the assessment? Select all that apply.

Where is the pain located?

Is there anything that makes the pain better?

What aggravates the pain?

Does your pain feel like throbbing or burning?

Does the pain radiate anywhere?

Question 9 of 10

At 10am, a client’s vital signs are as follows: HR 92, BP 128/84, RR 20, Temp 99.0. At 10:30, the nurse notes the client’s rhythm strip above on the monitor at the nurse’s station. Which of the following should the nurse’s first action be?

Notify the healthcare provider

Document sinus bradycardia in the client's medical record

Ask a UAP to retake the client's blood pressure

Assess the client's level of consciousness

Question 10 of 10

A client comes up to the medical unit from the ED with a temperature of 97.9s. Which of the following actions should the nurse take first?

Give the client warm blankets

Perform CPR

Tell the client to take deep breaths

Place a warming device on the client

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Hypertension Sphygmomanometer (Image)

Thermometer (Image)

Nursing Assessment (Book)

Vital Signs – Adult (Picmonic)

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Outline

Overview

Vital signs
1. Temperature
2. Pulse
3. Respirations
4. Blood Pressure
5. SpO2
6. Pain
Proper technique is required to ensure accuracy of results
Equipment needed
1. Stethoscope
2. Blood Pressure Cuff & Sphygmomanometer
  1. Or automated BP cuff
3. Thermometer
4. Pulse Oximeter
5. Watch with second hand

Nursing Points

General

Temperature
1. 97.8 – 99.1°F
2. Oral – place probe in pocket under tongue, have pt close mouth
  1. Not accurate if pt has eaten or drank in the last 15 minutes
3. Axillary – place probe in axilla and have pt put arm by their side
  1. Least accurate
4. Temporal – swipe across forehead or place on temple (follow manufacturer instructions)
5. Rectal – Apply small amount of lubricant jelly to probe, place probe in rectum and wait for result.
  1. Do not use excessive amounts of lubricant or results will be inaccurate
Pulse
1. 60 – 100 beats per minute
2. Apical – place stethoscope over the apex of the heart (5th intercostal space, left midclavicular line). Listen for a full minute
3. Radial – locate the groove below the thumb on the inside of the wrist to find the radial pulse. Count pulse for 30 seconds, multiply by 2
  1. Can also count for a full minute for more accuracy
4. Carotid – place two fingers on the thyroid cartilage, slide to the side into the groove, approximately 2 inches. Count pulse for 30 seconds and multiply by 2
  1. Never palpate bilateral carotid pulses at the same time
Respirations
1. 12 – 20 breaths per minute
2. Count breaths for 30 seconds, multiply by 2
3. TIPS:
  1. Do not tell the patient you are counting their breaths – they’ll breath differently
  2. After counting pulse for 30 seconds, continue holding pulse but count respirations for another 30 seconds
  3. Some thermometers have a timer function that will beep every 15 seconds. You can count respirations while waiting for the thermometer to result
Blood Pressure
1. <120 / <80 mmHg
2. Equipment required – stethoscope, cuff, sphygmomanometer
3. Position patient – sitting, legs uncrossed, arm at heart level
4. Ensure proper sizing of cuff
  1. Follow range lines on cuff
5. Steps for Manual:
  1. Feel for brachial pulse
  2. Wrap cuff around upper arm, leaving room for 2 fingers under cuff
    1. Arrow should point to the brachial pulse
  3. Place diaphragm of stethoscope over the brachial artery/pulse
  4. Tighten the valve on the bulb inflator
  5. Inflate the cuff until:
    1. Unable to hear brachial pulse (160 – 180 mmHg)
    2. 30-40 mmHg above patient’s baseline
  6. Slowly release the air from the cuff by opening the valve
    1. Should release 2-3 mmHg per second
  7. Listen for “boof” sound of pulse – the FIRST sound you hear is the Systolic BP
  8. The pulse sound will begin to fade – the LAST sound you hear is the Diastolic BP
  9. Do NOT watch the bouncing of the arm on the meter – only count based on what you hear
6. Document Systolic BP / Diastolic BP
SpO2 (Pulse Oximetry)
1. 95 – 100%
2. Ensure fingernail free of polish, warm hands with a warm towel if needed to improve circulation
3. Place probe with UV light on top of fingernail. Result will show within 3-5 seconds
4. Special probes also available for ears, noses, and foreheads
Pain
1. Subjective – whatever the patient says it is
2. Use appropriate pain scale to quantify the patient’s pain
3. Use PQRST or OLDCARTS to assess more details about pain

Assessment

Temperature
1. High
  1. Fever
  2. Infection
  3. Neurologic injury
  4. Hyperthyroidism
2. Low
  1. Exposure to cold
  2. Drug/alcohol abuse
  3. Diabetes
  4. Hypothyroidism
Pulse
1. High
  1. Fear/Anxiety
  2. Arrhythmia
  3. Hypovolemia
  4. Exertion/Activity
2. Low
  1. Arrhythmia
  2. Coronary artery disease
  3. Infection
  4. Electrolyte imbalance
  5. *May also be low baseline in very athletic patients
Respirations
1. High
  1. Fear/pain
  2. Asthma
  3. Pneumonia
  4. Neurologic injury
2. Low
  1. Alkalosis
  2. Neurologic injury
  3. Opioid overdose
  4. Oversedation
Blood Pressure
1. High
  1. Pain
  2. Heart failure
  3. Volume overload
  4. Kidney failure
  5. Neurological injuries
2. Low
  1. Medication reaction
  2. Shock
  3. Hemorrhage
  4. Arrhythmias
  5. *May also be low baseline in very athletic patients
SpO2
1. High
  1. O2 toxicity
2. Low
  1. Hypoxia
  2. Asthma/COPD
  3. ARDS
  4. Pneumonia
  5. Collapse
    1. Atelectasis
    2. Pneumothorax
    3. Hemothorax

Therapeutic Management

Note trends in vital signs
Report abnormal vitals to healthcare provider
Treat cause

Patient Education

Purpose for vital signs
Frequency of vital signs

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Transcript

In this video we’re going to walk you through proper technique on obtaining vital signs. It’s so important that you use the correct technique in order to obtain accurate results! The 5 vital signs we’ll review are Temperature, Pulse, Respirations, Blood Pressure, and SpO2 or Pulse Oximetry.

To take an oral temperature, remove the probe from the thermometer and attach a probe cover. Place the probe in the pocket under the tongue and have the patient close their mouth. Make sure they haven’t had anything to eat or drink in at least 15 minutes. Normal temperature for an adult is 97.8 to 99.1 degrees Fahrenheit.

To take an axillary temperature, place the covered probe under the patient’s arm, in the axilla, and have them place their arm by their side. While this isn’t the most accurate temperature, and usually runs a full degree lower than oral, it is a good option if the other routes are unavailable. You could also use a temporal thermometer or rectal temperature when appropriate.

Next, we check the pulse, which is the number of times the heart beats in one minute. Normal for an adult is 60 – 100 beats per minute. When checking a pulse, you have a few options. The first is the apical pulse. To get an apical pulse, place the diaphragm of your stethoscope over the apex of the heart – which is the 5th intercostal space, midclavicular line. Always listen for a full minute for an apical pulse.

To obtain a radial pulse, locate the groove just below the thumb on the inside of the patient’s wrist. Palpate the pulse and count for 30 seconds, then multiply by two. This will give you your beats per minute.

To obtain a Carotid pulse, place two fingers on the thyroid cartilage in the front of the neck, then slide your fingers to the side into the groove just below the jaw line. Again, you will want to palpate the pulse for 30 seconds and multiply that number by two. One important thing to know here is you should never palpate both carotid arteries at the same time.
When obtaining a patient’s respiratory rate, it’s important that you don’t tell them you are counting their breaths – otherwise they will breathe differently. One trick is to count the radial pulse for 30 seconds, then – while still holding the patient’s wrist, count the respirations for another 30 seconds, then multiply by two. The patient will think you’re still counting their pulse. You can also count respirations while waiting for the temperature to result. Some thermometers even have a timer function that will beep every 15 seconds so you can count respirations!

Getting a blood pressure isn’t always as simple as slapping a cuff on and pressing start. Sometimes we have to take the blood pressure manually. First things first, your patient should be sitting upright, legs uncrossed, with their arm at heart level – if that means you need to prop their arm up on a pillow, then do that. Then you want to make sure you have the right size cuff. Wrap the cuff around the top of their arm and look at the range markings. If the cuff is in range, you can use it – otherwise get a bigger or smaller size as needed.

Now you can get started. The first thing you need to do is feel for the patient’s brachial pulse on the inside of their elbow. Then you’re going to wrap the blood pressure cuff around their upper arm with the indicator line or arrow pointing to their brachial artery.

Make sure that you have the sphygmomanometer where you can see it and place your stethoscope over the Brachial artery.
Make sure the valve on the bulb inflator is closed. You’ll want to inflate the cuff by squeezing the bulb until you can’t hear the brachial pulse anymore, which on average is usually between 160 and 180 mmHg. OR inflate to about 30 to 40 mmHg above the patient’s baseline blood pressure.

Then, carefully open the valve very slowly and begin deflating the cuff at about 2-3 mmHg per second. As the pressure drops you will begin to hear a ‘boof’ pulse sound. Take note of the pressure at that moment – that is your systolic blood pressure.
Continue deflating until the pulse sound fades and you no longer hear it. The point at which you no longer hear the pulse is your diastolic blood pressure. Careful that you aren’t just watching the needle bounce, that won’t be accurate – it has to be what you hear. Once you have your numbers you can fully deflate and remove the cuff. This is a skill that takes a lot of practice, so grab a friend and practice on each other!

Last is pulse oximetry – first, make sure your patient’s fingers are nice and warm, you can even wrap them in a warm towel if you need to – because we need good circulation for the pulse ox. We also want them to have no nail polish on.
All you have to do is apply the probe with the red light on top of the fingernail and wait! You should get a result in about 5 seconds and that’s the number you’ll document. If you’re still having trouble with circulation, try a different hand, a toe, or you can even use probes for ears and noses as well!
Last, but certainly not least – DOCUMENT the vital signs!

We hope that was a helpful review on how to take a set of vital signs on an adult! The more you practice, the better you’ll get at it! Now, go out and be your best self today. And, as always, happy nursing!

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10.01 Arterial Blood Gas (ABG) Interpretation for CCRN Review

10.02 Breath Sounds for CCRN Review

ABG Course (Arterial Blood Gas) Introduction

Alkalosis and Acidosis Nursing Mnemonic (Kick Up, Drop Down)

Anatomy & Physiology Course Introduction

Anticholinergics – Side Effects Nursing Mnemonic (4 Can’ts)

Arterial Blood Gases Nursing Mnemonic (ROME)

Arterial Pressure Monitoring

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Renal (Kidney) Structure & Function

Renin Angiotensin Aldosterone System

Renin Angiotensin Aldosterone System (RAAS)

Respiratory A&P Module Intro

Respiratory Functions of Blood

Respiratory Structure & Function

Selecting THE vein

Skeletal Anatomy

Skeletal Muscle

Skin Structure & Function

Small Intestine

Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)

Tattoos IV Insertion

The EKG (ECG) Graph

Tonicity of Solutions – Live Tutoring Archive

Trach Suctioning

Two pathways of the peripheral nervous system Nursing Mnemonic (SAME)

Types of Epithelial (Skin) Tissue

Urinary Elimination

Urinary System Anatomy (Anatomy and Physiology)

12 Points to Answering Pharmacology Questions

6 Rights of Medication Administration

ACLS (Advanced cardiac life support) Drugs

Adenosine (Adenocard) Nursing Considerations

Amiodarone (Pacerone) Nursing Considerations

Anesthetic Agents

Anti-Infective – Antifungals

Anti-Platelet Aggregate

Antianxiety Meds

Antidepressants

Atenolol (Tenormin) Nursing Considerations

Atropine (Atropen) Nursing Considerations

Bariatric: IV Insertion

Basics of Calculations

Benztropine (Cogentin) Nursing Considerations

Bisacodyl (Dulcolax) Nursing Considerations

Buspirone (Buspar) Nursing Considerations

Carbidopa-Levodopa (Sinemet) Nursing Considerations

Cefdinir (Omnicef) Nursing Considerations

Celecoxib (Celebrex) Nursing Considerations

Codeine (Paveral) Nursing Considerations

Combative: IV Insertion

Complex Calculations (Dosage Calculations/Med Math)

Cyclosporine (Sandimmune) Nursing Considerations

Dark Skin: IV Insertion

Dimensional Analysis Nursing (Dosage Calculations/Med Math)

Diphenoxylate-Atropine (Lomotil) Nursing Considerations

Drawing Blood from the IV

Drawing Up Meds

Drug Interactions Nursing Mnemonic (These Drugs Can Interact)

Eye Prophylaxis for Newborn

Fentanyl (Duragesic) Nursing Considerations

Geriatric: IV Insertion

Giving Medication Through An IV Set Port

Glipizide (Glucotrol) Nursing Considerations

Guaifenesin (Mucinex) Nursing Considerations

Hanging an IV Piggyback

How to Remove (discontinue) an IV

How to Secure an IV (chevron, transparent dressing)

Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations

Hydromorphone (Dilaudid) Nursing Considerations

Injectable Medications

Insulin – Long Acting (Lantus) Nursing Considerations

Insulin – Mixtures (70/30)

Interactive Pharmacology Practice

Interactive Practice Drip Calculations

IV Catheter Selection (gauge, color)

IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)

IV Drip Administration & Safety Checks

IV Drip Therapy – Medications Used for Drips

IV Infusions (Solutions)

IV Insertion Angle

IV Insertion Course Introduction

IV Placement Start To Finish (How to Start an IV)

IV Pump Management

IV Push Medications

Ketorolac (Toradol) Nursing Considerations

Labeling (Medications, Solutions, Containers) for Certified Perioperative Nurse (CNOR)

Lidocaine (Xylocaine) Nursing Considerations

Magnesium Sulfate

Magnesium Sulfate in Pregnancy

Maintenance of the IV

Mannitol (Osmitrol) Nursing Considerations

Medication Errors

Medication Reconciliation Review for Certified Perioperative Nurse (CNOR)

Medications in Ampules

Meds for Postpartum Hemorrhage (PPH)

Meperidine (Demerol) Nursing Considerations

Methadone (Methadose) Nursing Considerations

Methylergonovine (Methergine) Nursing Considerations

Metoclopramide (Reglan) Nursing Considerations

Montelukast (Singulair) Nursing Considerations

Mood Stabilizers

Nalbuphine (Nubain) Nursing Considerations

Neostigmine (Prostigmin) Nursing Considerations

NG Tube Med Administration (Nasogastric)

NG Tube Medication Administration

Nitro Compounds

NRSNG Live | The S.O.C.K Method for Mastering Nursing Pharmacology and Never Forgetting a Medication Again

Nystatin (Mycostatin) Nursing Considerations

OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive

Olanzapine (Zyprexa) Nursing Considerations

Opioid Analgesics in Pregnancy

Oral Medications

Oxycodone (OxyContin) Nursing Considerations

Pain Management for the Older Adult – Live Tutoring Archive

Pain Management Meds – Live Tutoring Archive

Parasympathomimetics (Cholinergics) Nursing Considerations

Patient Controlled Analgesia (PCA)

Pediatric Dosage Calculations

Pentobarbital (Nembutal) Nursing Considerations

Pharmacodynamics

Pharmacokinetics

Pharmacokinetics Nursing Mnemonic (ADME)

Pharmacology Course Introduction

Phenobarbital (Luminal) Nursing Considerations

Phytonadione (Vitamin K) for Newborn

Pill Crushing & Cutting

Procainamide (Pronestyl) Nursing Considerations

Propofol (Diprivan) Nursing Considerations

Quetiapine (Seroquel) Nursing Considerations

Ranitidine (Zantac) Nursing Considerations

Rh Immune Globulin in Pregnancy

Sedatives-Hypnotics

Sedatives-Hypnotics

Selecting THE vein

Spiking & Priming IV Bags

Streptokinase (Streptase) Nursing Considerations

Struggling with Dimensional Analysis? – Live Tutoring Archive

SubQ Injections

Supplies Needed

Tattoos IV Insertion

The SOCK Method – C

The SOCK Method – K

The SOCK Method – O

The SOCK Method – Overview

The SOCK Method – S

The SOCK Method of Pharmacology 1 – Live Tutoring Archive

The SOCK Method of Pharmacology 2 – Live Tutoring Archive

The SOCK Method of Pharmacology 3 – Live Tutoring Archive

Tips & Advice for Newborns (Neonatal IV Insertion)

Tips & Advice for Pediatric IV

Understanding All The IV Set Ports

Using Aseptic Technique

Verapamil (Calan) Nursing Considerations

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