RAD1010 - CH 15 Vital Signs

Body homeostasis is often referred to as the body's "steady state" and is maintained by important body systems using physiologic feedback loops. Vital signs are an excellent indicator of the body's response to conditions and therapies the patient is undergoing. A key strength of using vital signs as an indicator of homeostasis is that they a. are subjective and subject to interpretation. b. are measured using interventional catheters and therefore are very accurate. c. an be assessed quickly, and the data revealed are objective. d. can be confirmed by asking the patient how he or she feels.

C Vital signs can be assessed quickly in the clinical setting and serve as objective, noninvasive evidence of the patient's immediate condition. They are reliable indicators of physiologic body processes.

The peak blood pressure reading, when measuring blood pressures, is a. diastolic pressure. b. systolic pressure. c. blood pressure resulting from right ventricular contraction. d. insignificant, as it does not truly indicate resting blood pressure.

B During a contraction of the heart, blood is ejected from the ventricles into the arterial blood vessels, creating an increase in pressure. The peak pressure present during contraction of the heart is known as the systolic pressure.

When taking a portable chest radiograph on a patient undergoing oxygen therapy, a. it is safe to remove the oxygen delivery during the setup and exposure. b. the oxygen should not be removed without the consent of a physician or respiratory care practitioner. c. the oxygen should be turned off briefly during the exposure to prevent an electrical spark. d. the oxygen delivery system should have a low flow rate only.

B If the oxygen device must be repositioned, the responsibility of the technologist is to ascertain that any tubing leading to the device is not kinked or disconnected and that the device is properly repositioned on the patient at the conclusion of the radiologic procedure. Under no circumstances should an oxygen device be completely removed from the patient for the purpose of taking a radiograph without the consent or supervision of a physician, respiratory care practitioner, or attending nurse.

Adequate breathing consists of a. good respiratory rate. b. good respiratory depth. c. 10 to 12 breaths/min. d. All of the above

D Adequate breathing (minute ventilation) is predicated on respiratory rate and depth of the breath. At rest, respiratory rates are at least 10 to 12 breaths/min.

The ideal location of the endotracheal tube tip is a. just below the junction of the esophagus and trachea. b. in the left or right mainstem bronchus. c. in the back of the throat. d. in the trachea 1 to 2 inches above the carina.

D After an endotracheal tube has been inserted, placement of the tube is confirmed by chest radiography and is assessed periodically thereafter. Properly positioned tubes will show the distal tip 1 to 2 inches (3 to 5 cm) superior to the tracheal bifurcation.

To measure blood pressures, you will need a a. thermometer and otoscope. b. stethoscope and pulse oximeter. c. sphygmomanometer and otoscope. d. stethoscope and sphygmomanometer.

D Blood pressure readings are obtained with the use of a sphygmomanometer and stethoscope.

While performing a portable chest radiograph on an uncooperative patient with a CV line inserted, you note that the catheter fixation material has loosened. Your responsibility as a professional radiographer is to a. quickly complete the exam as best you can, so as not cause any more harm. b. reattach the catheter line and complete the exam. c. take the chest image to assess the catheter tip position and its displacement. d. inform the patient's nurse of the catheter issue before taking the radiograph.

D One of the most critical concerns of radiographers is catheter dislodgment, which can be prevented only with increased awareness of the catheter's presence. Care must be exercised when handling patients with CV lines. Assessing the patient before performing radiographic procedures is essential to avert the possibility of line displacement.

A Swan-Ganz catheter differs from a central venous (CV) catheter in that Swan-Ganz a. lines measure arterial pressures in the wedge position and reflect pressure in the left atrium. b. catheters may be single-lumen or multilumen design, with a pressure electrode and cuff at the distal end. c. catheters are named after Jeremy Swan and William Ganz developers. d. All of the above are true.

D Pulmonary arterial (PA) lines were commonly called Swan-Ganz catheters, so named for the developers of the catheter. PA lines are specialized single-lumen or multilumen CV lines that incorporate at the distal end a small electrode used to monitor pulmonary artery pressures. PA lines are used to estimate left ventricular end-diastolic pressure.

A patient who has a temporal artery temperature of 100° F is a. febrile. b. hyperthermic. c. hypothermic. d. normal.

D The TA lies superficial in the temporal region of the skull. A noninvasive swipe of the thermometer along the forehead and across the temporal region provides immediate, accurate measures closely correlating to core body temperature. Today, TA thermometry is popular. A TA reading of 100° F is considered normal

When "high-flow" oxygen therapy is given, the _____ method is used. a. intracatheter b. nasal cannula c. nasogastric d. air-entrainment mask

D The facial mask, a high-flow device, is constructed to provide an accurate concentration of oxygen to the patient by propelling a high velocity of source oxygen through a narrowed opening near the mask. This method results in room air being drawn into the mask. The source oxygen, along with the entrained room air, provides a flow of gas that is capable of meeting the total need of the inspiratory capacity of the patient.

The objective of oxygen therapy is to a. produce a condition of hypoxemia. b. increase diaphragmatic movement to decrease tidal volume. c. increase the CO2 concentration going to the patient. d. increase the O2 concentration going to the patient.

D The primary clinical indications for oxygen administration are to correct hypoxemia. This is achieved by increasing oxygen levels in the blood. The overall goal of oxygen therapy is to maintain adequate tissue oxygenation while minimizing cardiopulmonary work.

To relieve a large tension pneumothorax, what kind of tube(s) is (are) inserted into the patient? a. Nasogastric b. Chest c. Thoracostomy d. Chest and Thoracostomy

D Thoracostomy (intrapleural) tubes, more commonly called chest tubes, are used to drain the intrapleural space and the mediastinum. Tension pneumothorax is a dramatic event that requires aggressive care. This condition requires a thoracostomy or chest tube insertion to relieve the pressure. Pressure increases on the ipsilateral side, causing a shift of the mediastinum toward the opposite side and producing a life-threatening event.

In a patient with hypoxia, a. heart rate decreases owing to high oxygen saturation values. b. respiratory rate remains unchanged. c. respiratory depth remains unchanged owing to increased cardiac output. d. blood pressure increases.

D Tissue hypoxia is a term used to describe an inadequate amount of oxygen at the cellular (tissue) level. When hypoxia is present, the metabolic rate of the body is compromised, resulting in altered homeostasis. To compensate for hypoxia, respiratory rates, depth of breathing, blood pressure, and heart rates increase.

A Swan-Ganz catheter is a. intended to measure venous pressure in the superior vena cava. b. used to measure pulmonary wedge pressures. c. also referred to as a PICC line. d. None of the above

B Pulmonary arterial (PA) lines are commonly called Swan-Ganz catheters, so named for the developers of the catheter. PA catheters have a balloon located at the distal end. During pressure monitoring, this balloon is inflated, allowing the catheter tip to float and wedge in a small pulmonary artery. During this interval, the electrode, at the most distal end of the catheter, measures PA (wedged capillary) pressures. PA-wedged pressure is indicative of left atrial pressure, which in turn is indicative of left ventricular pressure.

All of the following apply to respiratory measurements except a. a single respiration cycle consists of an inspiration and an expiration. b. the respiratory rate of newborns averages 12 to 20 breaths/min. c. adult respiration quality refers to rhythm, depth, and degree of effort. d. respiratory rates in children should be measured for at least one minute respiration measurements may alter if the patient is supine.

B Respiratory rates are measured as the number of breaths per minute; normal range at rest is 12 to 20 breaths/min. Newborns' respiratory rates average 30 to 60 breaths/min.

Thoracostomy tubes are used to a. biopsy chest tumors. b. reestablish negative intrapleural pressure. c. administer oxygen at high concentrations. d. administer chemotherapeutic drugs.

B Thoracostomy tubes are inserted through the chest wall to reestablish negative intrapleural pressure in cases of pneumothorax, hemothorax, pleural effusion, and empyema.

The collection of vital signs data is quick and noninvasive. The usual vital signs measured include a. electrolytes, blood gases, urinalysis values. b. temperature, pulse, respiration, and blood pressure. c. temperature, blood pressure, blood gases, and bowel sounds. d. respiration, pulse, cardiac output, and urinalysis values.

B. Collectively, the vital signs are body temperature, pulse rate, blood pressure, and respiratory rate. In addition, assessment of the patient's mental alertness (sensorium) is often reported along with the vital signs.

A reliable device to measure oxygen saturation levels of arterial blood is a a. sphygmomanometer. b. stethoscope. c. pulse oximeter. d. spirometer.

C A pulse oximeter is a noninvasive device used to provide ongoing assessment of the hemoglobin oxygen saturation of arterial blood as well as the patient's pulse rate. Normal pulse oximeter (SpO2) values for a healthy person are 95% to 100%.

A patient is thought to have had a cardiac arrest. The patient's pulse should be checked at the _____ artery. a. radial b. temporal c. carotid d. femoral

C During cardiac arrest, the pulse is routinely assessed at the carotid artery. To monitor the effectiveness of CPR compressions, peripheral pulse points—the femoral, pedal, and radial arteries—may also be assessed to verify the effectiveness of chest compressions.

From the choices below, the most accurate way to determine body temperature is a. taking a blood sample and recording its temperature. b. with an oral thermometer. c. with a rectal thermometer. d. by using both an oral and a rectal thermometer and averaging the readings.

C Even with all the newer measurement technologies, rectal thermometry is still believed to be the most accurate reflection of core body temperature. Temporal artery thermometry is gaining in popularity due to its convenience and accuracy, as well.

All of the following are related except a. oral. b. tympanic. c. inguinal. d. rectal.

C Five routes are commonly used to measure and extrapolate core body temperature: (1) oral, (2) axillary, (3) tympanic, (4) temporal, and (5) rectal. There is no body temperature measurement that is inguinal.

All of the following are true of oxygen therapy except a. the universal color of flowmeters is green. b. oxygen is considered a drug and is regulated by the government. c. oxygen therapy can be prescribed by pharmacists and respiratory therapists. d. oxygen delivery devices either have a low flow rate or a high flow rate.

C Oxygen is listed in the U.S. Pharmacopeia and is defined as a drug in the Federal Food, Drug, and Cosmetic Act of 1962. Similar to any drug, oxygen has both good and bad biologic effects; the minimum dose should always be given to obtain the desired result and no more. Therefore, a physician must prescribe oxygen.

All of the following are related except a. nasal cannula. b. facial mask. c. thoracostomy tube. d. tent and oxy hood

C Thoracostomy (intrapleural) tubes, more commonly called chest tubes (Figure 15.30), are used to drain the intrapleural space and the mediastinum.

The levels of blood pressures that are read on a sphygmomanometer are a. systolic over diastolic. b. diastolic over systolic. c. arterial over venous. d. None of the above

A Blood pressure measurements are expressed as the systolic pressure over the diastolic pressure. Normal blood pressure in a healthy adult includes a systolic pressure of less than 120 mm Hg and diastolic pressure of less than 80 mm Hg.

All of the following are true of body temperature measurement except a. all temperatures should be the same, regardless of where the temperature is measured. b. an oral temperature reading higher than 99.5° F indicates a fever. c. temporal artery (TA) measurements can be measured in 3 seconds noninvasively. d. rectal and TA measurement are typically 1° higher than oral readings.

A Body temperature readings may be measured in either degrees Fahrenheit (°F) or degrees Celsius (°C) and vary depending on where they are measured. Oral temperature readings in healthy adults and children are within the narrow range of 97.7° F to 99.5° F (36.5° C to 37.5° C). Tympanic measurements range from 95.9° F to 99.5° F (35.5° C to 37.5° C). Axillary temperatures register slightly lower, and rectal and TA temperatures register approximately 1° F higher than oral readings.

The term bradypnea is used to describe a. a decrease in respiratory rate. b. the depth of respiration. c. difficulty in breathing. d. absence of breathing.

A Bradypnea is the term used to describe a decrease in the respiratory rate. Bradypnea occurs much less frequently than tachypnea and results from depression of the respiratory center of the brain, which is common with drug overdoses, head trauma, and hypothermia.

The flow rate of oxygen therapy is given in a. liters per minute. b. cubic meters per minute. c. pounds per square inch. d. cubic centimeters.

A In terms of dosage, and depending on equipment, oxygen is usually ordered either in liters per minute or as a concentration.

You have completed a portable chest radiograph on a patient in the ICU. The image is positioned correctly and has acceptable image quality. When the correct placement of a central venous (CV) line using a right-sided approach is assessed, the catheter tip should a. not cross the midline of the patient and should be located in the superior vena cava. b. cross the patient's midline and be positioned in the thoracic duct. c. be located in the main pulmonary artery in a "wedge" position. d. be located in the left ventricle for accurate pressure measurement.

A Recognition of catheter malposition requires thorough knowledge of CV structures and their branches. Typically, CV lines inserted from a right-sided approach will follow the course of the subclavian vein in a latero-medial direction and then descend through the right brachiocephalic vein. From the right brachiocephalic vein, the catheter passes into the superior vena cava, where it should terminate above the right atrium. Because of the right-sided position of the superior vena cava, as the catheter advances, its image should remain to the right of the vertebral column and should not cross midline.

Which of the following is a common complication associated with CV line placement? a. Pneumothorax or hemothorax b. Tracheal erosion c. Laryngedema d. Atelectasis

A Regarding insertion problems, as many as one-third of CV catheters are placed incorrectly at insertion time. Malpositioning, pinching, and kinking also occur with significant frequency. Pneumothorax and hemothorax are potential complications associated with catheter insertions.

The preferred location of a central venous line tip is the a. superior vena cava. b. inferior vena cava. c. main pulmonary artery. d. jugular vein.

A The preferred location is the superior vena cava, approximately 2 to 3 cm above the right atrial junction.