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NUR 213 ( LATEST 2024 / 2025 ) EXAM 7 | ACTUAL QUESTIONS AND ANSWERS 100% CORRECT
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NUR 213 ( LATEST 2024 / 2025 ) EXAM 7 | ACTUAL QUESTIONS AND ANSWERS 100% CORRECT
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NUR 213 EXAM 71. What age should blood pressure be obtained for?
Answer
older than 3
2. Those that are not modifiable such as ethnicity, genetic, and natural hor- monal variations
Answer
intrinsic factors
3. Factors a client can control to some extent. ex) weight, use of stimulants, stress, and activity
level.
Answer
extrinsic factors
4. What is normal blood pressure?
Answer
less than 120 and less than 80
5. What is elevated blood pressure?
Answer
120-129 and less than 80
6. What is stage 1 hypertension?
Answer
130-139 or 80-90
7. Wha is hypertension stage 2?
Answer
140 or higher OR 90 or higher
8. What is a hypertensive crisis?
Answer
higher than 180 and/or higher than 120
9. Blood pressure is below the expected range, determined by a client's usual baseline.
Manifestations
Answer
dizziness, nausea, blurred vision, increased pulse, fatigue Interventions
Answer
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,increase fluids, upright position, meds
Answer
hypotension
10. High blood pressure. Risk for stroke and heart attack. Interventions
Answer
exer- cise, stress reduction, low-sodium diet, and weight loss
Answer
hypertension
11. What is the average pulse?
Answer
60 to 100 beats/min
12. A pulse over 100
Answer
tachycardia
13. A pulse less than 60
Answer
bradycardia
14. An irregular rhythm. Causes shortness of breath or dizziness
Answer
arrythmia
15. What are some things to remember when taking BP?
Answer
no legs crossed, support arm, inflate 30 mmHg extra, release at rate of 2 mmHg
16. When are vitals re-assessed?
Answer
4-8 hours, frequently after surgery
17. For a patient who had breast surgery you should never use the arm that had
Answer
removal of lymph nodes
18. -Drop in BP when patient sits or stands
-Nurse should take BP when patient is lying, siting, and then standings
-Can be caused by dehydration, heart failure
-Interventions
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, Answer
increase fluids, compression socks, change positions slowly, elevate head while sleeping, don't
sit or stand for too log
Answer
Orthostatic hypoten- sion
19. A difference between the apical pulse (chest) and a peripheral pulse (radi- al) in 1 minute.
-Causes
Answer
aortic rupture, coronary artery disease, or atrial fibrillation.
-Two nurses needed; one assesses apical while the other assesses peripher- al.
Answer
pulse deficit
20. Can a nurse delegate the measure of vital signs to an AP?
Answer
yes as long as patient is stable, they must report the measurements to the RN
21. When is body temp lowest? When is it highest?
Answer
morning, afternoon
22. An increase in body temperature
Answer
hyperthermia
23. A decrease in core body temperature
Answer
hypothermia
24. What are the sides where temperature can be measured?
Answer
oral, tympanic membrane, temporal artery, axillary, and rectal
25. Type of electronic thermometer that measures the amount of heat radiating from the tympanic
membrane. Inserted into the ear canal.
Answer
tympanic thermome- ter
26. Measures temperature through the temporal artery. Considered an accu- rate measurement.
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