Chapter 30 to Chapter 42: Vital Signs
Potter et al.: Fundamentals of Nursing,
9th Edition MULTIPLE CHOICE
Chapter 30: Vital Signs
1. A patient has a
... [Show More] head injury and damages the hypothalamus. Which vital sign will the
nurse monitor most closely?
a. Pulse
b. Respirations
c. Temperature
d. Blood pressure
2. A patient presents with heatstroke. The nurse uses cool packs, cooling blanket, and a
fan. Which technique is the nurse using when the fan produces heat loss?
a. Radiation
b. Conduction
c. Convection
d. Evaporation
3. The patient has a temperature of 105.2° F. The nurse is attempting to lower
temperature by providing tepid sponge baths and placing cool compresses in strategic
body locations. Which technique is the nurse using to lower the patient’s temperature?
a. Radiation
b. Conduction
c. Convection
d. Evaporation
4. A nurse is focusing on temperature regulation of newborns and infants. Which action
will the nurse take?
a. Apply just a diaper.
b. Double the clothing.
c. Place a cap on their heads.
d. Increase room temperature to 90 degrees.
5. The nurse is working the night shift on a surgical unit and is making 4:00 AM rounds.
The nurse notices that the patient’s temperature is 96.8° F (36° C), whereas at 4:00 PM
the preceding day, it was 98.6° F (37° C). What should the nurse do?
a. Call the health care provider immediately to report a possible infection.
b. Administer medication to lower the temperature further.
c. Provide another blanket to conserve body temperature.
d. Realize that this is a normal temperature variation.
6. The nurse is caring for a patient who has a temperature reading of 100.4° F (38° C).
The patient’s last two temperature readings were 98.6° F (37° C) and 96.8° F (36° C).
Which action will the nurse take?
b. Wait 30 minutes and recheck the patient’s temperature.
c. Assume that the patient has an infection and order blood cultures.
d. Encourage the patient to move around to increase muscular activity.
e. Be aware that temperatures this high are harmful and affect patient safety.
7. A patient is pyrexic. Which piece of equipment will the nurse obtain to monitor this
condition?
a. Stethoscope
a. Thermometer
b. Blood pressure cuffc. Sphygmomanometer
8. The nurse is caring for a patient who has an elevated temperature. Which principle will
the nurse consider when planning care for this patient?
a. Hyperthermia and fever are the same thing.
b. Hyperthermia is an upward shift in the set point.
c. Hyperthermia occurs when the body cannot reduce heat production.
d. Hyperthermia results from a reduction in thermoregulatory mechanisms.
9. The patient with heart failure is restless with a temperature of 102.2° F (39° C). Which
action will the nurse take?
a. Place the patient on oxygen.
b. Encourage the patient to cough.
c. Restrict the patient’s fluid intake.
d. Increase the patient’s metabolic rate.
10. The patient requires temperatures to be taken every 2 hours. Which task will the nurse
assign to an RN?
a. Using appropriate route and device
b. Assessing changes in body temperature
c. Being aware of the usual values for the patient
d. Obtaining temperature measurement at ordered frequency
11. The patient requires routine temperature assessment but is confused, easily agitated,
and has a history of seizures. Which route will the nurse use to obtain the patient’s
temperature?
a. Oral
b. Rectal
c. Axillary
d. Tympanic
12. The patient is being admitted to the emergency department following a motor vehicle
accident. The patient’s jaw is broken with several broken teeth. The patient is ashen, has
cool skin, and is diaphoretic. Which route will the nurse use to obtain an accurate
temperature reading?
a. Oral
b. Axillary
c. Tympanic
d. Temporal
13. The nurse is caring for an infant and is obtaining the patient’s vital signs. Which
artery will the nurse use to bestobtain the infant’s pulse?
a. Radial [Show Less]