Exam (elaborations)
Chapter 11 Vital Signs
- Course
- Nursing
- Institution
- Western Piedmont Community College
Chapter 11 Vital Signs
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Chapter 11: Vital SignsMULTIPLE CHOICE
1. What part of the body maintains a balance between heat production and heat loss, regulating
body temperature?
a. Thymus
b. Thyroid
c. Hypothalamus
d. Adrenal glands
ANS: C
Body temperature is regulated by the hypothalamus.
PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 257
OBJ: 9 | 13 TOP: Vital signs KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
2. What type of body temperature remains relatively constant?
a. Surface
b. Rectal
c. Oral
d. Core
ANS: D
The core body temperature remains relatively constant.
PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 257
OBJ: 2 TOP: Vital signs KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
3. The nurse uses cooling techniques to keep the body temperature below 105° F. What can
result from an elevated temperature?
a. Excessive thirst
b. Excessive perspiration
c. Damage to body cells
d. Increased heart rate
ANS: C
If the temperature exceeds 105° F, normal body cells may be damaged.
PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 258
OBJ: 8 TOP: Vital signs KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
4. The emergency department nurse quickly assesses the temperature of an unconscious patient
who has been outside all night in below-freezing temperatures. What temperature is the nurse
aware of that can lead to death?
a. 95.2° F
b. 93.0° F
, c. 93.2° F
d. 90.8° F
ANS: C
Death can occur if the temperature falls below 93.2° F.
PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 258
OBJ: 9 TOP: Vital signs KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
5. What is the term for a fever that rises and falls but does not return to normal until the patient
is well?
a. Constant
b. Intermittent
c. Remittent
d. Elevated
ANS: C
A remittent fever does not return to normal until the patient becomes well.
PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 258
OBJ: 9 TOP: Remittent fever
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
6. How should the nurse position the ear pinna when using the tympanic thermometer on a
child?
a. Upward and back
b. Parallel
c. Downward and back
d. Upward and forward
ANS: C
Using the tympanic thermometer for a child, the nurse will tug the ear pinna down and back.
PTS: 1 DIF: Cognitive Level: Application REF: Page 262, Skill 11-1
OBJ: 3 | 9 TOP: Tympanic thermometer for a child
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
7. How should the nurse position the earpieces on a stethoscope to ensure optimum reception?
a. Backward
b. Parallel to the ears
c. Toward the face
d. Downward
ANS: C
To ensure the best reception of sound, place earpieces pointing toward the face.
PTS: 1 DIF: Cognitive Level: Application REF: Page 264
OBJ: 9 | 12 TOP: Vital signs KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
8. What does the nurse use the diaphragm of the stethoscope to best assess?
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