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RN Vital Signs Assessment (ATI) Questions and Answers | Latest Version | 2025/2026 | Correct & Verified
When assessing blood pressure, what should the nurse do if the first reading is elevated?✔✔A. Wait 1-2 minutes and take the reading again
- Take the reading again immediately
- Notify the provider without retaking the reading
- Recheck the blood pressure every 15 minutes
What is the primary purpose of measuring oxygen saturation with a pulse oximeter?
- To assess respiratory rate
- To assess circulation
- To measure heart rate
✔✔B. To determine the percentage of oxygen in the blood
What action should be taken if a client reports pain during a vital sign check?
- Continue with the assessment as normal
✔✔B. Document the pain and assess the pain level separately 1 / 4
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- Skip the pain assessment and move to the next step
- Immediately call for assistance from another nurse
Which of the following is true regarding blood pressure measurement?
- Blood pressure should be taken immediately after physical activity
- A higher cuff size results in a lower reading
- A lower cuff size results in a more accurate reading
✔✔C. Blood pressure readings should be taken with the client seated with feet flat on the floor
What is considered a normal range for a newborn’s heart rate?✔✔A. 120 to 160 bpm
- 80 to 100 bpm
- 100 to 120 bpm
- 60 to 80 bpm
What should the nurse do if the client’s blood pressure is 160/110 mmHg on the first measurement?✔✔A. Recheck the blood pressure after a few minutes 2 / 4
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- Notify the healthcare provider immediately and document the reading
- Ignore it as a one-time occurrence
- Apply ice packs to the arms to lower the reading
What is the correct action if a pulse oximeter reading is below 90%?
- Turn off the machine and restart
- Increase the oxygen flow rate
- Administer pain medication immediately
✔✔B. Check the placement of the sensor and assess the patient’s clinical status
What is the correct method for measuring oral temperature in an adult?
- Place the thermometer under the tongue and have the patient breathe through their nose
- Ask the patient to chew gum before taking the temperature
- Place the thermometer under the tongue with the mouth slightly open
✔✔B. Place the thermometer under the tongue and have the patient close their mouth
What is the correct method for measuring blood pressure in a patient with an IV in the arm?✔✔A. Use the opposite arm if possible 3 / 4
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- Measure the blood pressure through the IV arm
- Apply a larger cuff over the IV site
- Measure the blood pressure at the thigh
Which is the best way to assess the respiratory rate of a pediatric patient?✔✔A. Observe the chest rise and fall for one full minute
- Count the breaths for 30 seconds and multiply by 2
- Count breaths while the child is playing
- Ask the child to breathe in and out deeply
What is an acceptable range for a toddler's respiratory rate?
- 8 to 12 breaths per minute
- 12 to 16 breaths per minute
- 30 to 40 breaths per minute
✔✔C. 20 to 30 breaths per minute
What is the normal range for an adult’s blood pressure?
- 90/60 to 120/80 mmHg
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