Vital Signs
What is the normal respiration rate?
12 - 20 rpm (respirations per minute)
What is the normal oral temperature range? (Celsius or Fahrenheit)
96.8 – 100.4°F (36.0 – 38.0°C); Average 98.6°F (37.0°C)
The patient resting heart rate is 35 bpm. What is the medical term for this heart rate?
Bradycardia
How many ounces (oz) in a pound (lb)?
16 ounces (oz)
How many ounces (oz) in a pound (lb)?
How many ounces equal 1 cup?
8 ounces (oz)
How many ounces equal 1 cup?
A female 74 year old patient presents today to the clinic with oral temperature of 101.2 F or 38.4 C. and is anxious, complains of burning sensation while voiding. She is with her grandson, who says she was 100.0 F yesterday, so he thought she was fine. Answer the 2 questions: Is she having a fever today? Was she having a fever yesterday?
Today she is having a fever. Yesterday, she was not having a fever.
What is normal heart rate range ?
60 to 100 bpm (beats per minute)
What is the normal temporal temperature range?
97.8 – 101.4°F (36.5 – 38.5°C)
The patient's daughter is visiting her mother Hannah Baker and is taking care of her mom post right hip replacement and post hip fracture. The daughter is upset that her mom's blood pressure is 132/84 and wants to know what the rehab facility is going to do now that her blood pressure is very high. What is your response? Is her blood pressure elevated?
Reassure the patient that her blood pressure is normal. It could be related to other factors such as pain. Review the prior blood pressure in the last few hours and last day and describe to patient and family the trend.
How many pounds (lb) in 1 kilogram?
2.2 pounds (lb)
How many pounds (lb) in 1 kilogram?
1 cup equals how many milliliters ?
240 ml
1 cup equals how many milliliters ?
Which is not a normal vital sign?
a) 111/60
b) respirations 12
c) temperature 34.7 C or 94.6F
d) 98% oxygen saturation on room air
c - The temperature is low or showing signs of hypothermia.
The patient could be showing signs of shivering. Are they pale? Are their fingernails or skin color blue or purple? Do they have enough clothes on, do they have wet clothes on? It also could be medication related or chronic disease related due to their diabetes, heart disease, etc. that could make it difficult to regulate their body temperature. The patient could have low blood sugar/hypoglycemia (cold and clammy give candy).
The patient O2 saturation is currently at 96%. The patient's family ask if that is okay as it seems low. What do you tell the patient and their family?
The normal oxygen saturation range is 95 - 100 %. The patient's oxygen is normal.
You could ask what the patient's normal oxygen saturation rate is and/or ask about their respiratory history. You could also review the chart and look at the prior history for comparison.
What is the normal axillary temperature range ?
95.9 – 99.5°F (35.5 – 37.5°C)
Hypotension range?
BP < 90/60 mmHg
How many grams in 1 ounce?
30 grams
(How many grams in 1 ounce?)
1 teaspoon (tsp) equals how many milliliters (mL) ?
5 ml
Your patient has been drinking normally today and voided 200 ml in 10 hours, is this normal and what are your next steps? Name or list at least 3.
No (correct answer)
(discussion led - double check I&Os with nursing assistant, had they documented everything, assess patient, any urinary symptoms, complications, then notify the provider)
The patient complains of pain to their back at a scale of 6/10. After repositioning the patient and non-pharmacological interventions, what is the nurses next step to assist the patient?
We medicate > 3. Check to see if there are PRN medications to address the patient's back pain. They might have tylenol, etc.
Pain scale range: 0 to 10
The patient's temperature is > 102.2°F orally. What is the medical term for this temperature? What is at least one non pharmacological intervention that you could do before seeing if they need medications ?
Hypothermia.
Assess your patient, is it a true elevated temperature, recheck the temperature, verify they were not drinking hot liquids prior to the temperature (if someone else did the vital signs), remove thick blankets, remove any warm/hot drinks, cooling measures (ice packs under axillae)....
Hypertension range?
BP > 139/89 mmHg
1 grain (gr) equals how many milligrams (mg) ?
65mg or 60 mg
0.065 mg or 0.06mg
1 grain (gr) equals how many milligrams (mg) ?
1 quart equals how many milliliters
960 ml
The patient's oxygen saturation is 85%. What is your next step?
a) call the doctor
b) assess your patient (ADPIE), check your equipment and oxygen sensor
c) put them on oxygen nasal cannula per the urgent/emergent protocol at your facility
b) assess your patient (ADPIE), check your equipment and oxygen sensor
What is the parameter of urinary output minimum per hour ?
30ml/hr
What oral temperature is considered hypothermia ?
< 95.0°F oral
Stacy's blood pressure is 82/50. What are your nursing interventions ? List at least 3
Make sure she is on a safe surface, if standing have her sit and lie down (use gravity to help circulation and blood flow return to her head), consider giving her oral fluids, recheck blood pressure and her vital signs including oxygenation, assess if she is symptomatic (dizzy, lightheaded)
BP ranges 90/60 < 120/80 – 139/89 mmHg
What is tachypnea ?
> 20 RPM
(per Stanbridge Vital Signs Handout >24 rpm, will clarify)
One gram equals how many grains ?
15 grains
The patient's heart rate is 112. The patient is anxious.