Vital Signs Practice Questions

81 multiple-choice questions on Vital signs for paramedic and EMT students, from Chapter 11 (Patient Assessment). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

81 practice questions

1. A normal adult resting heart rate is:

   1. A. 50 to 90 beats/min
   2. B. 100 to 120 beats/min
   3. C. 40 to 60 beats/min
   4. D. 60 to 100 beats/min
   Show answer

   Answer: D. 60 to 100 beats/min

   Athletes may be normal at lower rates.

2. A normal adult respiratory rate is:

   1. A. 20 to 30 breaths/min
   2. B. 12 to 20 breaths/min
   3. C. 8 to 10 breaths/min
   4. D. 6 to 12 breaths/min
   Show answer

   Answer: B. 12 to 20 breaths/min

   Rate alone does not tell you whether ventilation is adequate.

3. Pulse quality should be described as:

   1. A. Rate as a number only
   2. B. Present or absent only
   3. C. Strength and regularity
   4. D. Fast or slow only
   Show answer

   Answer: C. Strength and regularity

   Describe it as strong, weak, thready, or bounding, and regular or irregular. A weak, thready pulse suggests poor perfusion.

4. Respirations should be counted:

   1. A. Without the patient's awareness
   2. B. Only once the patient is on oxygen
   3. C. For 5 seconds and multiplied
   4. D. After telling the patient to relax
   Show answer

   Answer: A. Without the patient's awareness

   Knowing alters the rate. Count while appearing to take the pulse.

5. The systolic blood pressure represents:

   1. A. The average pressure across the cycle
   2. B. Pressure during ventricular relaxation
   3. C. The difference between two readings
   4. D. Pressure during ventricular contraction
   Show answer

   Answer: D. Pressure during ventricular contraction

   Diastolic reflects the resting pressure between contractions.

6. Pulse pressure is:

   1. A. The mean arterial pressure
   2. B. Systolic divided by two
   3. C. Systolic plus diastolic
   4. D. Systolic minus diastolic
   Show answer

   Answer: D. Systolic minus diastolic

   A narrowing pulse pressure is an early clue to shock.

7. Palpating a blood pressure provides:

   1. A. A more accurate reading
   2. B. Both systolic and diastolic
   3. C. Mean arterial pressure
   4. D. Only a systolic value
   Show answer

   Answer: D. Only a systolic value

   Document it as palpated, for example 90 systolic by palpation.

8. A blood pressure cuff that is too small will:

   1. A. Give a falsely high reading
   2. B. Have no effect
   3. C. Give a falsely low reading
   4. D. Prevent measurement
   Show answer

   Answer: A. Give a falsely high reading

   Cuff width should cover about two-thirds of the upper arm.

9. Pulse oximetry measures:

   1. A. Arterial oxygen pressure (PaO2)
   2. B. Exhaled carbon dioxide
   3. C. Oxygen delivered to tissues
   4. D. Percent of hemoglobin saturated
   Show answer

   Answer: D. Percent of hemoglobin saturated

   It reports the percentage of hemoglobin binding sites occupied. It does not tell you whether ventilation is adequate.

10. Pulse oximetry may be falsely normal in:

    1. A. Acute asthma attack
    2. B. Severe pneumonia
    3. C. Carbon monoxide poisoning
    4. D. Anemia from blood loss
    Show answer

    Answer: C. Carbon monoxide poisoning

    Carboxyhemoglobin is read as saturated hemoglobin.

11. Pulse oximetry may read inaccurately in:

    1. A. Patients receiving oxygen
    2. B. Young, healthy patients
    3. C. Warm, well-perfused patients
    4. D. Poor perfusion or hypothermia
    Show answer

    Answer: D. Poor perfusion or hypothermia

    Poor perfusion, hypothermia, motion, and some nail polish cause errors. Treat the patient, not the number.

12. Waveform capnography measures:

    1. A. Tidal volume per breath
    2. B. Exhaled carbon dioxide
    3. C. Arterial oxygen saturation
    4. D. Respiratory rate only
    Show answer

    Answer: B. Exhaled carbon dioxide

    It reflects ventilation, perfusion, and metabolism. It is the standard for confirming and monitoring advanced airway placement.

13. A normal end-tidal carbon dioxide value is approximately:

    1. A. 50 to 60 mm Hg
    2. B. 10 to 20 mm Hg
    3. C. 35 to 45 mm Hg
    4. D. 20 to 30 mm Hg
    Show answer

    Answer: C. 35 to 45 mm Hg

    It falls with hyperventilation and with poor perfusion.

14. A sudden drop of end-tidal carbon dioxide to near zero suggests:

    1. A. A dislodged tube or lost pulse
    2. B. Improved ventilation and perfusion
    3. C. Hypoventilation from sedation
    4. D. A normal response to oxygen
    Show answer

    Answer: A. A dislodged tube or lost pulse

    Causes include a dislodged tube, an obstruction, or loss of circulation. Verify placement and check for a pulse immediately.

15. Skin that is cool, pale, and clammy suggests:

    1. A. Poor perfusion
    2. B. Fever and infection
    3. C. Normal perfusion
    4. D. Heat exhaustion only
    Show answer

    Answer: A. Poor perfusion

    Sympathetic activation and poor perfusion. It is one of the earliest signs of shock.

16. Pupils that are unequal in a patient with altered mental status may indicate:

    1. A. Simple hypoglycemia
    2. B. Generalized hypoxia
    3. C. Increased intracranial pressure
    4. D. Normal anatomic variation
    Show answer

    Answer: C. Increased intracranial pressure

    Increased intracranial pressure or brain injury. A small number of people have normally unequal pupils, so history matters.

17. Blood glucose should be checked in any patient with:

    1. A. Fever without other symptoms
    2. B. Altered mental status or seizure
    3. C. Chest pain as the only complaint
    4. D. Isolated extremity trauma
    Show answer

    Answer: B. Altered mental status or seizure

    Check it with altered mental status, seizure, stroke symptoms, or unexplained weakness. Hypoglycemia mimics many conditions and is quickly correctable.

18. Vital signs should be reassessed:

    1. A. Only after each intervention is given
    2. B. Every 5 minutes if unstable, 15 if stable
    3. C. Once during transport, then at handoff
    4. D. Only when the patient reports a change
    Show answer

    Answer: B. Every 5 minutes if unstable, 15 if stable

    Trends carry more information than a single set.

19. Vital signs include:

    1. A. Pulse, pupils, and blood glucose
    2. B. Pulse, blood pressure, and GCS only
    3. C. Blood pressure and the SAMPLE history
    4. D. Pulse, respirations, BP, and temperature
    Show answer

    Answer: D. Pulse, respirations, BP, and temperature

    Pulse, respirations, blood pressure, temperature, and often oxygen saturation and pain. Some add end-tidal CO2.

20. Vital signs should be obtained:

    1. A. Only if the first set is abnormal
    2. B. At least twice
    3. C. Only at the hospital
    4. D. Once, at first contact
    Show answer

    Answer: B. At least twice

    At least twice, with more frequent sets for unstable patients. Trends matter.

21. A pulse is palpated with:

    1. A. The fingertips
    2. B. The flat palm
    3. C. The thumb pad
    4. D. The back of the hand
    Show answer

    Answer: A. The fingertips

    The thumb has its own pulse.

22. Pulse should be counted for:

    1. A. 10 seconds, times six
    2. B. 5 seconds, times twelve
    3. C. 2 full minutes in all cases
    4. D. 30 seconds, or 60 if irregular
    Show answer

    Answer: D. 30 seconds, or 60 if irregular

    At least 30 seconds, or a full minute if irregular. Irregular rhythms need longer.

23. A bounding pulse suggests:

    1. A. Hypovolemic shock
    2. B. Severe hypotension
    3. C. Fever or hypertension
    4. D. Complete heart block
    Show answer

    Answer: C. Fever or hypertension

    Hypertension, fever, or early sepsis. High stroke volume.

24. A thready pulse suggests:

    1. A. Fever or early sepsis
    2. B. A well-conditioned heart
    3. C. Shock or poor perfusion
    4. D. Severe hypertension
    Show answer

    Answer: C. Shock or poor perfusion

    Weak and rapid.

25. An irregular pulse suggests:

    1. A. Fever or dehydration
    2. B. A dysrhythmia
    3. C. A normal finding
    4. D. High blood pressure
    Show answer

    Answer: B. A dysrhythmia

    A dysrhythmia such as atrial fibrillation. Get an ECG.

26. Pulse deficit refers to:

    1. A. A weak, thready radial pulse
    2. B. An absent peripheral pulse
    3. C. A rate below 60 per minute
    4. D. Apical rate exceeds radial rate
    Show answer

    Answer: D. Apical rate exceeds radial rate

    It is the difference between the apical and radial pulse rates, seen in atrial fibrillation.

27. Bradycardia in an adult is a rate under:

    1. A. 100
    2. B. 60
    3. C. 50
    4. D. 80
    Show answer

    Answer: B. 60

    May be normal in athletes.

28. Tachycardia in an adult is a rate over:

    1. A. 80
    2. B. 100
    3. C. 150
    4. D. 120
    Show answer

    Answer: B. 100

    Many causes.

29. Respirations are assessed for:

    1. A. Depth and chest rise only
    2. B. Rate alone, counted for a minute
    3. C. Effort and skin color only
    4. D. Rate, depth, rhythm, and effort
    Show answer

    Answer: D. Rate, depth, rhythm, and effort

    Rate, depth, rhythm, effort, and sounds. Quality matters.

30. After a fall, a patient has a BP of 112/96 and a heart rate of 118. How should you interpret this?

    1. A. Normal, because the systolic pressure is above 90
    2. B. Widened pulse pressure from rising intracranial pressure
    3. C. Hypertension needing an antihypertensive
    4. D. Narrow pulse pressure; compensated shock
    Show answer

    Answer: D. Narrow pulse pressure; compensated shock

    Pulse pressure is systolic minus diastolic, so here it is 16 mm Hg (normal is about 40). With tachycardia, a narrowing pulse pressure reflects vasoconstriction as the body compensates for blood loss. A normal systolic does not exclude shock. Rising ICP widens the pulse pressure, and these readings are not hypertensive.

31. Normal adult tidal volume is approximately:

    1. A. 100 mL
    2. B. 200 mL
    3. C. 1,000 mL
    4. D. 500 mL
    Show answer

    Answer: D. 500 mL

    5 to 7 mL/kg.

32. Labored breathing is indicated by:

    1. A. Accessory muscle use and retractions
    2. B. Slow, deep, and quiet respirations
    3. C. A normal rate with quiet breathing
    4. D. Pink skin and full sentences
    Show answer

    Answer: A. Accessory muscle use and retractions

    Also nasal flaring and tripod position. Effort.

33. Agonal respirations are:

    1. A. Normal sleeping breaths
    2. B. Effective slow breaths
    3. C. Ineffective gasps
    4. D. Fast, shallow breaths
    Show answer

    Answer: C. Ineffective gasps

    They are ineffective gasps indicating cardiac arrest. Begin CPR.

34. Blood pressure measurement requires:

    1. A. The largest cuff available
    2. B. The smallest cuff available
    3. C. Any cuff that fits around
    4. D. A correctly sized cuff
    Show answer

    Answer: D. A correctly sized cuff

    The bladder should cover about 80 percent of arm circumference. Wrong size, wrong reading.

35. A cuff too large will:

    1. A. Give a falsely high reading
    2. B. Not inflate
    3. C. Be accurate
    4. D. Give a falsely low reading
    Show answer

    Answer: D. Give a falsely low reading

    Opposite of too small.

36. Auscultated blood pressure uses:

    1. A. A pulse oximeter waveform
    2. B. Palpation of the radial artery pulse
    3. C. A stethoscope over the brachial artery
    4. D. Doppler over the radial artery
    Show answer

    Answer: C. A stethoscope over the brachial artery

    Korotkoff sounds are heard over the brachial artery. The gold standard in the field.

37. Korotkoff sounds are:

    1. A. Normal heart valve closure sounds
    2. B. Bronchial breath sounds
    3. C. Murmurs from a heart valve
    4. D. Sounds of returning arterial flow
    Show answer

    Answer: D. Sounds of returning arterial flow

    They are heard as blood flow returns through the compressed artery. First sound is systolic, disappearance is diastolic.

38. The cuff should be inflated to:

    1. A. 30 mm Hg above pulse loss
    2. B. 10 mm Hg above the usual systolic
    3. C. 200 mm Hg in every patient
    4. D. 100 mm Hg in every patient
    Show answer

    Answer: A. 30 mm Hg above pulse loss

    About 30 mm Hg above the point where the pulse disappears. Avoid over-inflation. Inflating just 10 mm Hg above a usual reading can start below the true systolic and miss it, and fixed targets ignore the patient's actual pressure.

39. The cuff should be deflated at:

    1. A. 2 to 3 mm Hg per second
    2. B. 10 mm Hg per second
    3. C. 1 mm Hg every 5 seconds
    4. D. As fast as possible
    Show answer

    Answer: A. 2 to 3 mm Hg per second

    Too fast misses the sounds.

40. Palpated blood pressure is documented as:

    1. A. Systolic over 0, as in 110/0
    2. B. Diastolic over P, as in 70/P
    3. C. Systolic over diastolic
    4. D. Systolic over P, as in 110/P
    Show answer

    Answer: D. Systolic over P, as in 110/P

    No diastolic.

41. Automated blood pressure devices:

    1. A. Never accurate enough to use
    2. B. Useful but can be inaccurate
    3. C. A full replacement for manual
    4. D. Always accurate in the field
    Show answer

    Answer: B. Useful but can be inaccurate

    Motion, dysrhythmias, or extreme pressures cause errors. Verify manually when unsure.

42. Blood pressure should be taken in both arms when:

    1. A. Aortic dissection is suspected
    2. B. The patient is a healthy child
    3. C. The patient has an ankle injury
    4. D. The first arm reading is normal
    Show answer

    Answer: A. Aortic dissection is suspected

    Suspected aortic dissection (tearing chest or back pain) calls for blood pressure in both arms; a difference over 20 mm Hg is significant. A healthy child, an isolated ankle injury, or a normal first reading gives no reason to suspect a difference between arms.

43. Hypertension in an adult is generally defined as:

    1. A. 140/90 or higher, repeated
    2. B. 120/80 or higher, once
    3. C. 130/80 or higher, repeated
    4. D. 160/100 or higher, once
    Show answer

    Answer: C. 130/80 or higher, repeated

    Guidelines have lowered thresholds.

44. Hypotension in an adult is generally:

    1. A. Systolic under 70
    2. B. Systolic under 90
    3. C. Systolic under 120
    4. D. Systolic under 100
    Show answer

    Answer: B. Systolic under 90

    Systolic under 90 or a significant drop from baseline. Baseline matters.

45. Orthostatic hypotension is defined as:

    1. A. Systolic falling 20 or diastolic 10
    2. B. Any drop in pressure on standing
    3. C. A pulse rise of 5 on standing
    4. D. A rise of 20 systolic on standing
    Show answer

    Answer: A. Systolic falling 20 or diastolic 10

    A systolic drop of 20 or diastolic drop of 10 mm Hg on standing, or symptoms.

46. Temperature can be measured:

    1. A. Only by touching the forehead
    2. B. Only rectally, the sole accurate route
    3. C. Only orally, in every adult patient
    4. D. At several sites, such as oral or rectal
    Show answer

    Answer: D. At several sites, such as oral or rectal

    Orally, rectally, tympanically, temporally, or axillary. Accuracy varies.

47. Core temperature is best measured:

    1. A. Rectally or by esophageal probe
    2. B. In the axilla under a closed arm
    3. C. Orally with a digital thermometer
    4. D. Tympanically with an infrared probe
    Show answer

    Answer: A. Rectally or by esophageal probe

    Important in hypothermia.

48. Normal body temperature is approximately:

    1. A. 36 degrees C
    2. B. 39 degrees C
    3. C. 37 degrees C
    4. D. 35 degrees C
    Show answer

    Answer: C. 37 degrees C

    98.6 degrees F.

49. Fever is generally defined as a temperature above:

    1. A. 39 degrees C
    2. B. 38 degrees C
    3. C. 37 degrees C
    4. D. 40 degrees C
    Show answer

    Answer: B. 38 degrees C

    100.4 degrees F.

50. Hypothermia is defined as a core temperature below:

    1. A. 36 degrees C
    2. B. 35 degrees C
    3. C. 34 degrees C
    4. D. 37 degrees C
    Show answer

    Answer: B. 35 degrees C

    95 degrees F.

51. A hypothermic patient with cold, mottled fingers has an erratic pleth waveform and an SpO2 of 82%. What should you do?

    1. A. Try a warmer site such as the ear or forehead
    2. B. Accept 82% as accurate and intubate right away
    3. C. Remove the probe, since oximetry never works
    4. D. Increase the oxygen until it reads 100%
    Show answer

    Answer: A. Try a warmer site such as the ear or forehead

    Poor perfusion, cold, and motion make readings unreliable, which shows as a poor waveform. Move the probe to a better-perfused central site and assess the patient clinically. Do not act on a poor signal alone. Oximetry is still useful when the signal is good, and oxygen should be titrated to the patient, not pushed to 100%.

52. A normal pulse oximetry reading is:

    1. A. 85 to 90 percent
    2. B. 90 to 94 percent
    3. C. 95 to 100 percent
    4. D. 80 to 85 percent
    Show answer

    Answer: C. 95 to 100 percent

    Below 90 is hypoxemia.

53. A drowsy patient with COPD has an SpO2 of 94% on oxygen and an ETCO2 of 68 mm Hg. What does this show?

    1. A. Both oxygenation and ventilation are within normal limits
    2. B. The capnography reading must be a device error
    3. C. Oxygenation is adequate, but ventilation is failing
    4. D. He is hyperventilating and needs coaching
    Show answer

    Answer: C. Oxygenation is adequate, but ventilation is failing

    Pulse oximetry measures oxygen saturation, while capnography measures ventilation. With supplemental oxygen, SpO2 can look fine while CO2 rises, and drowsiness with an ETCO2 of 68 means hypercapnic respiratory failure that may need assisted ventilation. Normal ETCO2 is 35 to 45, so this is not normal, not hyperventilation, and not a reason to dismiss the monitor.

54. A patient can have normal saturation and still be:

    1. A. Hypoventilating with rising carbon dioxide
    2. B. Hypoxemic with a PaO2 below 60 mmHg
    3. C. Cyanotic from low hemoglobin saturation
    4. D. Alkalotic from carbon dioxide retention
    Show answer

    Answer: A. Hypoventilating with rising carbon dioxide

    Oxygen masks hypoventilation.

55. End-tidal carbon dioxide measures:

    1. A. Arterial oxygen saturation trends
    2. B. Oxygenation at the alveolar level
    3. C. Ventilation, and indirectly perfusion
    4. D. Tissue oxygen delivery directly
    Show answer

    Answer: C. Ventilation, and indirectly perfusion

    It also reflects metabolism indirectly. The missing vital sign.

56. The capnography waveform of a wheezing patient shows a sloped 'shark fin' shape. This suggests:

    1. A. A displaced endotracheal tube
    2. B. Bronchospasm slowing exhalation
    3. C. Normal ventilation with no obstruction
    4. D. Cardiac arrest with poor CPR
    Show answer

    Answer: B. Bronchospasm slowing exhalation

    When airflow is obstructed, as in asthma or COPD, the lungs empty slowly, and the expiratory upstroke slopes into a shark-fin shape. A displaced tube causes loss of the waveform. Normal ventilation produces a square box, and poor CPR produces low ETCO2 values rather than this shape.

57. Rising end-tidal carbon dioxide suggests:

    1. A. Decreasing perfusion from shock
    2. B. Tube displacement into the esophagus
    3. C. Hyperventilation from pain or anxiety
    4. D. Hypoventilation or increased metabolism
    Show answer

    Answer: D. Hypoventilation or increased metabolism

    Also return of circulation during CPR.

58. Falling end-tidal carbon dioxide suggests:

    1. A. Hyperventilation or falling perfusion
    2. B. Hypoventilation or rising metabolism
    3. C. Fever with increased CO2 production
    4. D. Return of spontaneous circulation
    Show answer

    Answer: A. Hyperventilation or falling perfusion

    A sudden drop can also mean tube displacement. Context determines.

59. End-tidal carbon dioxide during CPR reflects:

    1. A. Ventilation adequacy, not circulation
    2. B. Neurologic outcome after resuscitation
    3. C. Oxygen saturation of arterial blood
    4. D. Compression quality and chance of ROSC
    Show answer

    Answer: D. Compression quality and chance of ROSC

    Over 10 suggests adequate compressions.

60. A man found at a bus stop smells of alcohol and slurs his words. What should you check before attributing this to alcohol?

    1. A. A breathalyzer alcohol level
    2. B. Serum potassium level
    3. C. Blood glucose
    4. D. Peak expiratory flow
    Show answer

    Answer: C. Blood glucose

    Hypoglycemia, head injury, stroke, and hypoxia can all mimic intoxication. Glucose is fast to check and easy to treat, and alcohol itself can cause hypoglycemia. A breathalyzer does not exclude another cause, potassium is not a field test, and peak flow has nothing to do with this presentation.

61. Normal blood glucose is approximately:

    1. A. 40 to 60 mg/dL
    2. B. 200 to 300 mg/dL
    3. C. 150 to 200 mg/dL
    4. D. 70 to 110 mg/dL
    Show answer

    Answer: D. 70 to 110 mg/dL

    Fasting.

62. Hypoglycemia is generally defined as glucose under:

    1. A. 40 mg/dL or lower only
    2. B. 100 mg/dL at any time
    3. C. 50 mg/dL in adults only
    4. D. 70 mg/dL with symptoms
    Show answer

    Answer: D. 70 mg/dL with symptoms

    Treat symptomatic patients.

63. Pain as a vital sign is assessed using:

    1. A. The provider's judgment of severity
    2. B. Vital sign changes such as heart rate
    3. C. Observed facial expression alone
    4. D. A 0 to 10 or faces scale, reassessed
    Show answer

    Answer: D. A 0 to 10 or faces scale, reassessed

    Reassess after every treatment. Document before and after.

64. Pupils are assessed for:

    1. A. Size and shape only, not light response
    2. B. Reactivity to light and gaze direction only
    3. C. Equality and visual acuity in each eye
    4. D. Size, equality, and reactivity to light
    Show answer

    Answer: D. Size, equality, and reactivity to light

    PERRL.

65. Pinpoint pupils suggest:

    1. A. Opioid use or pontine lesion
    2. B. Sympathetic stimulation or cocaine
    3. C. Anticholinergic or atropine toxicity
    4. D. Early herniation from head injury
    Show answer

    Answer: A. Opioid use or pontine lesion

    Consider naloxone.

66. Dilated, unresponsive pupils suggest:

    1. A. Normal sleep in a low-light room
    2. B. Severe brain hypoxia or brain death
    3. C. Cholinergic or organophosphate poisoning
    4. D. Opioid overdose or pontine stroke
    Show answer

    Answer: B. Severe brain hypoxia or brain death

    Anticholinergic toxicity can also produce dilated pupils. Context.

67. A single dilated pupil in an injured patient suggests:

    1. A. Opioid toxicity affecting one side
    2. B. Increased ICP with uncal herniation
    3. C. Hypoglycemia with focal deficits
    4. D. Normal variation needing no action
    Show answer

    Answer: B. Increased ICP with uncal herniation

    Ominous.

68. Vital sign norms for children:

    1. A. Are too variable to be useful
    2. B. Match adult norms after age two years
    3. C. Vary by age and must be referenced
    4. D. Run higher for blood pressure than adults
    Show answer

    Answer: C. Vary by age and must be referenced

    Carry a reference.

69. Vital signs in pregnancy:

    1. A. Remain unchanged from prepregnancy
    2. B. Show higher heart rate and lower BP
    3. C. Show lower heart rate and higher BP
    4. D. Show higher BP and slower breathing
    Show answer

    Answer: B. Show higher heart rate and lower BP

    Heart rate rises and blood pressure dips slightly in the second trimester. Baseline shifts.

70. Vital signs in athletes:

    1. A. Run higher due to greater muscle mass
    2. B. May show normal resting bradycardia
    3. C. Should match nonathlete norms exactly
    4. D. Show bradycardia that is always abnormal
    Show answer

    Answer: B. May show normal resting bradycardia

    Low resting blood pressure may also be normal for them. Baseline matters.

71. Vital signs in older adults:

    1. A. May be blunted by medications
    2. B. Are usually abnormal at baseline
    3. C. Are more reliable than in younger adults
    4. D. Respond more strongly to shock
    Show answer

    Answer: A. May be blunted by medications

    Physiologic changes of aging also blunt responses. Beta blockers mask tachycardia.

72. Trending vital signs is more useful than a single set because:

    1. A. Direction of change shows deterioration
    2. B. Averaging values removes all error
    3. C. Single readings are always inaccurate
    4. D. Hospitals require multiple readings
    Show answer

    Answer: A. Direction of change shows deterioration

    Trends reveal improvement as well as deterioration. Rising heart rate, falling pressure.

73. After 2 days of vomiting, a patient has a HR of 88 and BP of 118/76 lying down. On standing, the HR is 122 and BP 94/60, and she is dizzy. This indicates:

    1. A. Orthostatic changes suggesting volume depletion
    2. B. A normal response to standing in a healthy adult
    3. C. Hypertension made worse by changing position
    4. D. A cardiac cause, since the heart rate went up
    Show answer

    Answer: A. Orthostatic changes suggesting volume depletion

    A drop of 20 mm Hg or more in systolic pressure, a heart rate rise of about 30, and symptoms on standing indicate orthostatic hypotension, which is typical of volume depletion. In healthy people the heart rate rises slightly and BP is maintained. These numbers are not hypertensive, and a rising heart rate is the expected compensation, not proof of a cardiac cause. Do not stand a patient who is already hypotensive while supine.

74. A blood pressure taken with the patient's arm hanging well below heart level will read:

    1. A. Falsely low
    2. B. Accurately, since arm position does not matter
    3. C. Accurately, but only in obese patients
    4. D. Falsely high
    Show answer

    Answer: D. Falsely high

    The column of blood below the heart adds hydrostatic pressure, so an arm held below heart level reads falsely high, and an arm above heart level reads falsely low. Support the arm at heart level. Arm position affects every patient.

75. Which vital sign change is the earliest sign of shock?

    1. A. Bradycardia and rising blood pressure
    2. B. Hypotension and widened pulse pressure
    3. C. Fever with warm, flushed extremities
    4. D. Tachycardia and narrowed pulse pressure
    Show answer

    Answer: D. Tachycardia and narrowed pulse pressure

    Compensation.

76. Which vital sign is the latest sign of shock?

    1. A. Tachycardia
    2. B. Tachypnea
    3. C. Pallor
    4. D. Hypotension
    Show answer

    Answer: D. Hypotension

    Decompensation.

77. Cushing triad includes:

    1. A. Hypotension, tachycardia, rapid breathing
    2. B. Hypertension, bradycardia, irregular breathing
    3. C. Hypotension, bradycardia, deep breathing
    4. D. Hypertension, tachycardia, and irregular breathing
    Show answer

    Answer: B. Hypertension, bradycardia, irregular breathing

    Late sign of ICP.

78. Beck triad includes:

    1. A. Tracheal deviation, JVD, and hypotension
    2. B. Muffled heart sounds, JVD, and hypotension
    3. C. Hypertension, bradycardia, irregular breathing
    4. D. Muffled heart sounds, JVD, and hypertension
    Show answer

    Answer: B. Muffled heart sounds, JVD, and hypotension

    Tamponade.

79. Which vital sign is most affected by anxiety?

    1. A. Pupil size and oxygen saturation
    2. B. Temperature and pupil reactivity
    3. C. Temperature and blood glucose
    4. D. Heart rate and respiratory rate
    Show answer

    Answer: D. Heart rate and respiratory rate

    Rule out organic causes first.

80. Documenting vital signs requires:

    1. A. Times only, with values on the monitor
    2. B. Values only, since times are implied
    3. C. Values, times, and patient position
    4. D. The first set only, unless abnormal
    Show answer

    Answer: C. Values, times, and patient position

    Note activity when relevant. Context.

81. Which statement about vital signs is accurate?

    1. A. Vital signs are rarely useful
    2. B. Normal vital signs exclude serious illness
    3. C. Normal vital signs do not exclude serious illness
    4. D. Abnormal vital signs always indicate disease
    Show answer

    Answer: C. Normal vital signs do not exclude serious illness

    Interpret with the whole picture.