Basic Nursing Skills Vital Signs & Patient Monitoring 2 — Questions and Answers
Question 1: A patient's oxygen saturation (SpO2) reads 91% on room air. The nurse should:
- Document and continue monitoring
- Apply supplemental oxygen immediately (Correct answer)
- Reposition the patient and recheck
- Notify the provider if it drops below 85%
Correct answer: Apply supplemental oxygen immediately
SpO2 below 94% in most adults warrants supplemental oxygen and immediate nursing intervention.
Question 2: Which device is used to non-invasively measure oxygen saturation?
- Sphygmomanometer
- Pulse oximeter (Correct answer)
- Spirometer
- Capnograph
Correct answer: Pulse oximeter
A pulse oximeter clips onto a fingertip or earlobe to measure SpO2 non-invasively via light wavelengths.
Question 3: What does a widened pulse pressure (>40 mmHg) most commonly indicate?
- Dehydration
- Aortic regurgitation or increased intracranial pressure (Correct answer)
- Hypothyroidism
- Anemia
Correct answer: Aortic regurgitation or increased intracranial pressure
A widened pulse pressure can indicate aortic regurgitation, elevated intracranial pressure, or other hemodynamic changes.
Question 4: Bradycardia in an adult is defined as a heart rate below:
- 50 bpm
- 60 bpm (Correct answer)
- 70 bpm
- 80 bpm
Correct answer: 60 bpm
Bradycardia is defined as a heart rate below 60 beats per minute in an adult.
Question 5: Which factor can cause a falsely low pulse oximetry reading?
- Elevated hemoglobin
- Peripheral vasoconstriction (Correct answer)
- High ambient temperature
- Hyperventilation
Correct answer: Peripheral vasoconstriction
Peripheral vasoconstriction reduces blood flow to the fingertip, resulting in a falsely low SpO2 reading.
Question 6: When counting respirations, the nurse should count for at least how many seconds?
- 15 seconds then multiply by 4
- 20 seconds then multiply by 3
- 30 seconds then multiply by 2
- 60 seconds for a full count (Correct answer)
Correct answer: 60 seconds for a full count
Respiratory rate should be counted for a full 60 seconds to detect irregular breathing patterns accurately.
Basic Nursing Skills Vital Signs & Patient Monitoring 2
A patient's oxygen saturation (SpO2) reads 91% on room air.
The nurse should: