Chapter 9 - General Survey, Measurement and Vital Signs (Review Questions)

A temperature of 98.6°F (degrees Fahrenheit) equals __.0°C (degrees Celcius). Fill in the correct number.

37 Formula (F-32) x 5/9 = C

Which patients would you describe as having bradycardia? (Select all that apply). A. An 89-year-old with a pulse of 46 bpm B. A 74-year-old with a pulse of 50 bpm C. A 56-year-old with a pulse of 54 bpm D. A 38-year-old with a pulse of 48 bpm E. A 22-year-old with a pulse of 60 bpm

A. An 89-year-old with a pulse of 46 bpm D. A 38-year-old with a pulse of 48 bpm In the adult, a resting heart rate of less than 50 beats per minute (bpm) is bradycardia. Heart rates in the 50s per minute occur normally in the well-trained athlete whose heart muscle develops along with skeletal muscle. The stronger, more efficient heart muscle pushes outer a larger stroke volume with each beat, thus requiring fewer beats per minute to maintain a stable cardiac output.

Which technique should be used for a routine pulse assessment? A. Count the radial pulse for 30 seconds starting with zero and multiply by 2. B. Count the radial pulse for 10 seconds starting with 1 and multiply by 6. C. Count the apical pulse for 60 seconds. D. Count the pulse for 15 seconds and multiply by 4.

A. Count the radial pulse for 30 seconds starting with zero and multiply by 2.

Which factors do you observe when assessing a patient's mobility? (Select all that apply). A. Gait B. Body position C. Range of motion. D. Posture E. Stature

A. Gait C. Range of motion. When assessing a patient's mobility, you should observe gait and range of motion. Body position, posture, and stature are parameters of the assessment of body structure.

A 57-year-old male patient presents with complaints about feelings of depression. While conducting the general survey, you pay particular attention to the behavior assessment. In addition to facial expression, speech, speech pattern, and dress, which factors does this assessment include? A. Mood/affect and personal hygiene C. Presence of depression, and the number of hours spent in bed per day C. Memory and behaviors representative of dementia D. Personal hygiene and vocabulary

A. Mood/affect and personal hygiene The behavior assessment component of the general survey includes the parameters of mood/affect and personal hygiene as well as facial expression, speech, speech pattern, and dress.

When measuring blood pressure, which errors in technique result in a falsely high diastolic reading? (Select all that apply). A. Patient's legs are crossed. B. Arm with the cuff is above the level of the heart. C. Too much pressure is placed on the diaphragm of the stethoscope. D. Arm with the cuff is not supported. E. Cuff is deflated too slowly.

A. Patient's legs are crossed. D. Arm with the cuff is not supported. E. Cuff is deflated too slowly. Faulty leg position, such as having the legs crossed, results in both falsely high diastolic and systolic readings. Having the patient support his or her own arm or deflating the cuff too slowly results in a falsely high diastolic reading. Taking a blood pressure in an arm above the level of the heart results in a falsely low pressure. Pushing too hard on the diaphragm of the stethoscope results in a falsely low diastolic pressure.

When assessing the pulse, which parameters are included? A. Rate, rhythm, and force B. Rate, rhythm, tempo, and presence of skipped beats C. Rate, rhythm, force, and strength D. Rate, rhythm, and tempo

A. Rate, rhythm, and force Assessment of the pulse includes checking the rate, rhythm, and force. The pulse rate is the number of beats per minute. The rhythm is the tempo and is normally regular. The force is the strength of the heart's stroke volume.

Mrs. Freeman is a 53-year-old patient who comes to the clinic for a follow-up blood pressure check. How would the blood pressure reading be affected if you wrapped the cuff too loosely? A. Readings would be falsely high. B. Readings would be falsely lower. C. Readings would be unaffected provided the cuff width was correct. D. Readings would be either falsely high or low depending on the diameter of the patient's arm.

A. Readings would be falsely high. A cuff wrap that is too loose or uneven or one that has the bladder ballooning out will cause a falsely high blood pressure because of the excessive pressure required to occlude the brachial artery. A cuff wrap that is too tight will cause a falsely low blood pressure

You are doing a complete physical examination on a new patient. As part of the examination, you take the patient's blood pressure in both arms and find an 18-mm Hg difference between the two. What should you do? A. Take the blood pressures again later in the examination. B. Obtain a thigh blood pressure for comparison. C. Repeat the blood pressure immediately using a Doppler flowmeter. D. Measure blood pressures both sitting and standing.

A. Take the blood pressures again later in the examination. You should repeat the blood pressures later in the examination to determine if the difference in blood pressure in the two arms was reproducible. If yes, you should refer the patient because a reproducible difference in the two arms of more than 10 to 15 mm Hg may indicate arterial obstruction on the side with the lower reading.

Mrs. Jones brings her son in for a follow-up well-child visit. As the health care provider, how often do you measure the head circumference? A. At birth and then during every well-child visit until 2 years of age B. At birth, at each well-child visit until 2 years of age, and then annually until 6 years of age C. At birth and then every 6 months until 2 years of age D. At birth and then annually until 6 years of age

B. At birth, at each well-child visit until 2 years of age, and then annually until 6 years of age Head circumference is measured at birth, at each well-child visit until 2 years of age, and then annually until 6 years of age. The measurement is plotted on a standardized growth chart and the patient's measurement is compared with that expected for age. The pattern of head growth is more significant than any single measurement figure.

Under which assessment category of the general survey are nutritional status, posture, position while seated, and the presence of a physical handicap or deformity documented? A. Physical appearance B. Body structure C. Mobility D. Behavior

B. Body structure Nutritional status, posture, position while seated, and the presence of a physical handicap or deformity are documented under body structure. Age, sex, level of consciousness, skin color, and facial features are documented under physical appearance. Gait and range of motion are documented under mobility. Facial expression, mood/affect, speech, speech pattern, dress, and personal hygiene are documented under behavior.

You assess a patient's gait as he walks from the waiting room to the exam room. In so doing, you keep in mind which fact about the base of support? A. Normally it is half the height of the person. B. Normally it is equal to shoulder width. C. Normally it is dependent on height. D. Normally it is proportionate to arm length.

B. Normally it is equal to shoulder width. Normally, when walking, the base is as wide as the shoulder width; foot placement is accurate; the walk is smooth, even, and well-balanced; and associated movements, such as symmetric arm swing, are present. The width of the base is not related to height nor is it proportionate to arm length.

A 53-year-old patient has had consistent blood pressure readings in the 125−136/66−78 range. How would you classify this patient in terms of blood pressure? A. Normal B. Prehypertension C. Stage 1 hypertension D. Stage 2 hypertension

B. Prehypertension Adults older than age 18 are classified as prehypertensive if systolic blood pressure is 120 to 139 or the diastolic pressure is 80 to 89. Normal blood pressure in an adult is systolic less than 120 and diastolic less than 80. Systolic blood pressure of 140 to 159 or diastolic pressure of 90 to 99 is Stage 1 hypertension. Systolic blood pressure of 160 or greater or diastolic pressure of 100 or greater is Stage 1 hypertension.

Which physiologic measures normally exhibit a ratio of 4:1? A. Systolic mm Hg to diastolic mm Hg B. Pulse beats per minute to respirations per minute C. Degrees centigrade of temperature to cardiac contractions D. Milliliters of stroke volume to apical pulse beats per minute

B. Pulse beats per minute to respirations per minute A fairly constant ratio of pulse rate to respiratory rate exists and is about 4:1. Normally both pulse and respiratory rates rise as a response to exercise or anxiety.

As part of the general survey, the examiner compares the patient's appearance to which factor? A. Reported mood B. Stated age C. Documented occupation D. Recorded ethnicity

B. Stated age The general survey area of physical appearance includes statements that compare appearance to the patient's stated age. Appearance older than the biological age can indicate chronic disease or chronic alcoholism, among other factors.

1. Mr. Ward is a 58-year-old patient who presents with exogenous obesity. When discussing this problem with Mr. Ward, what information is appropriate to include? (Select all that apply.) A. Excessive catabolism is responsible for his weakness, thin arms and legs, and reduced height. B. This type of obesity is one in which body fat is evenly distributed. C. Muscle wasting is a primary characteristic of exogenous obesity. D. Exogenous obesity is due to caloric intake being greater than caloric expenditure. E. This type of obesity is accompanied by thin, fragile skin with purple abdominal striae, bruising, and acne.

B. This type of obesity is one in which body fat is evenly distributed. D. Exogenous obesity is due to caloric intake being greater than caloric expenditure. With exogenous obesity, body fat is the result of excessive caloric intake and is evenly distributed. Muscle strength is intact. Weakness, thinning extremities, muscle wasting, and reduced height are characteristics of endogenous obesity, as is a thin, fragile skin often with bruising and acne.

Mrs. Bergen brings her 14-month-old son to the clinic for a follow-up well-child visit. Which technique should be your best choice for measuring his height? A. Use a tape measure while the infant is supine, measuring head to waist and then waist to toe. B. Use a horizontal measuring board. C. Use a stadiometer. D. Measure arm span to estimate height.

B. Use a horizontal measuring board. Use of a horizontal measuring board is the best method to measure the height of older infants. Use of a tape measure is inaccurate. A stadiometer is used for children age 2 or 3 years. Although arm span (fingertip to fingertip) should equal height, it is not the recommended method of measurement.

What is a common error in blood pressure measurement? A. Taking blood pressure in an arm that is at the level of the heart. B. Waiting less than 1 to 2 minutes before repeating the blood pressure reading on the same arm. C. Waiting 30 minutes if the client has just smoked a cigarette. D. Using a blood pressure cuff with a bladder that is 80% of the patient's arm circumference.

B. Waiting less than 1 to 2 minutes before repeating the blood pressure reading on the same arm. Waiting less than 1 to 2 minutes before repeating the blood pressure (BP) reading on the same arm can lead to a falsely high diastolic pressure reading because of venous congestion in the forearm. BP should be taken in an arm at the level of the heart. It is appropriate to wait at least 30 minutes before taking a BP of someone who has just smoked a cigarette, as is using a BP cuff with a bladder that is 80% of the patient's arm circumference.

On which patient should you obtain serial blood pressure measurements (lying supine, sitting, standing)? A. A patient with a pulse deficit of 10 beats per minute. B. A patient presenting with a severe headache of sudden onset. C. A patient brought to the clinic after fainting. D. A patient with a 16-mm gap between phases IV and V of Korotkoff sounds.

C. A patient brought to the clinic after fainting. Serial measurements of pulse and blood pressure should be taken when the patient reports fainting or syncope; when the patient is known to have hypertension or is taking antihypertensive medication; or when you suspect volume depletion.

In a patient with a normal hemoglobin, what is the lowest clinically acceptable arterial oxygen saturation (SpO2) value? A. Greater than 90% B. Greater than 93% C. Greater than 95% D. Greater than 97%

C. Greater than 95% The lowest clinically acceptable arterial oxygen saturation (Spo2) value is greater than 95% in the presence of a normal hemoglobin. A healthy person without lung disease normally has an Spo2 of 97% to 99%.

Which is the best technique for measuring the respiratory rate? A. Inform the person of the procedure and count for 1 minute. B. Watch the patient's back and count respirations for 15 seconds; then multiply the result by 4. C. Maintain position and count for 30 seconds after completing a pulse assessment. D. Use a stethoscope to count the apical pulse for 60 seconds, followed by counting the respirations for a full minute.

C. Maintain position and count for 30 seconds after completing a pulse assessment. For an accurate assessment of respirations, maintain your position of counting the radial pulse and unobtrusively count the respirations for 30 seconds, or for a full minute if you suspect an abnormality. Because most people are unaware of their breathing, do not mention that you will be counting the respirations, because sudden awareness may alter the normal respiratory pattern. Avoid the 15-second interval. The result can vary by a factor of ±4, which is significant with such a small number.

Which assessment finding supports the conclusion that the patient has endogenous obesity? A. Body fat is evenly distributed. B. Patient reports a sedentary lifestyle and high caloric intake. C. Patient has marked central trunk and cervical fat. D. Muscle strength is normal.

C. Patient has marked central trunk and cervical fat. With endogenous obesity, body fat is the result of production of excess cortisol by the adrenal cortex in response to either administration of adrenocorticotropin (ACTH) or excessive production of ACTH by the pituitary gland. With endogenous obesity, there is marked central trunk and cervical fat, muscle wasting, weakness, thinning extremities, and reduced height. Also, the skin is thin and fragile and often marked with bruising and acne.

What are the four distinct, overriding categories of assessment that comprise the general survey? A. Personal hygiene, dress, speech, and mood/affect B. Gait, range of motion, mental status, and behavior C. Physical appearance, body structure, mobility, and behavior D. Level of consciousness, personal hygiene, mental status, and physical condition

C. Physical appearance, body structure, mobility, and behavior The four distinct, overriding areas of assessment that comprise the general survey are physical appearance, body structure, mobility, and behavior. Parameters falling within the category of physical appearance are age, sex, level of consciousness, skin color, facial features, and overall appearance. Parameters in the category of body structure are stature, nutrition, symmetry, posture, position, body build, and obvious physical deformities. Parameters in the category of mobility are gait, range of motion, and absence of involuntary movement. Parameters in the category of behavior are facial expression, mood and affect, speech, speech pattern, dress, and personal hygiene.

You are previewing a patient's record and see a notation of "Pulse 2+." How do you interpret this information? A. Pulse was weaker than expected. B. Pulse was thready. C. Pulse had normal force. D. Pulse had a bounding quality

C. Pulse had normal force. The force of the pulse is recorded on a scale of 0, which is absent, to 3+, which is full or bounding. A score of 2+ indicates normal force, while 1+ indicates the pulse was weak or thready.

Ms. Herblew is a 21-year-old patient who presents with a complaint of fever. You use a temporal artery thermometer to check her current temperature. Which guideline should be followed when using this type of thermometer? A. Run the probe over the skin from the patient's hairline down over the cheek. B. Touch the probe lightly to the skin in front of and just above the ear and wait 10 seconds. C. Slide the probe across the patient's forehead and behind the ear. D. Hold the probe for 6 seconds over the patient's right or left temple.

C. Slide the probe across the patient's forehead and behind the ear. The temporal artery thermometer is used by sliding the probe across the patient's forehead and down behind the ear. The thermometer works by taking multiple readings and providing an average in about 6 seconds.

Mr. Walker, a 50-year-old patient with long-standing hypertension, comes to the clinic for a blood pressure check. Which guideline will you keep in mind when choosing a cuff to use? A. Use an adult cuff on adults and a child's cuff on children. B. Always use a thigh cuff on an obese client. C. Use a cuff with a bladder length equaling 80% of the client's arm circumference. D. Use a cuff with a bladder width equaling 80% of the length of a client's upper arm

C. Use a cuff with a bladder length equaling 80% of the client's arm circumference. An appropriate-size blood pressure cuff has a bladder length that equals 80% of the client's arm circumference. If an improperly sized cuff is used, the blood pressure measurement will be inaccurate.

You are using a Doppler flowmeter to obtain a blood pressure reading in the radial artery. Once you locate the artery, you begin to inflate the cuff. How far above the point at which the sounds disappear do you continue to inflate it? A. 0 mm Hg B. Approximately 10 mm Hg C. Between 10 and 20 mm Hg D. Between 20 and 30 mm Hg

D. Between 20 and 30 mm Hg The cuff is inflated 20 to 30 mm Hg beyond the point at which sounds disappear. This is true regardless of location of the cuff and is done to help ensure that the first sounds are not missed and a falsely low blood pressure reading is obtained.

The general survey for an infant or child consists of which assessment categories? A. Facial characteristics, mobility, body structure, behavior, maternal bonding B. Physical appearance, mobility, body contour, behavior, prenatal bonding C. Physical stature, parent nurturing, body contour, behavior, mobility D. Physical appearance, mobility, body structure, behavior, parental bonding

D. Physical appearance, mobility, body structure, behavior, parental bonding The five assessment categories comprising an infant's or child's general survey are physical appearance, mobility, body structure, behavior, and parental bonding.

A 12-year-old is brought to the emergency room by his mother, who states that he complained of a headache and sick stomach and, when she took his temperature, it was 104.8°F. Which type of temperature should you obtain on this boy? A. Tympanic membrane temperature B. Temporal artery temperature C> Oral temperature D. Rectal temperature

D. Rectal temperature With a report of a temperature as high as 104.8°F, accuracy of the current reading is essential. Therefore, you should obtain a rectal temperature because it is the most accurate measure of core body temperature outside of the more invasive measures reserved for the operating room and critical care unit.

Which guideline should be considered regarding blood pressures taken at the thigh? A. Compare thigh pressure with blood pressure measured at the arm in children or adolescents with low blood pressure. B. Expect thigh pressure to be lower than blood pressure measured at the arm. C. Suspect a septal defect if thigh pressure is found to be higher than arm blood pressure. D. Refer the patient for evaluation for coarctation of the aorta if arm pressure is higher than thigh pressure.

D. Refer the patient for evaluation for coarctation of the aorta if arm pressure is higher than thigh pressure. Normally, the thigh pressure is higher than blood pressure (BP) in the arm. If the arm pressure is found to be higher than BP in the thigh, it is important that the patient be evaluated for coarctation of the aorta (a congenital form of narrowing). Thigh pressure is measured and compared with the BP in the arm if the BP measured at the arm is excessively high, particularly in adolescents and young adults.