Observation, Vital Signs and Reporting — practice questions

10% of the exam ≈7 real questions 10 free questions here

Ten percent of the exam: taking temperature, pulse and respiration, what is normal, what to report right away, and how to write it down. Federal rules list temperature, pulse and respiration by name, and the skills test usually includes a measurement.

Where people lose points

• Adult pulse is 60 to 100; adult respirations are 12 to 20. The two ranges are swapped in distractors constantly.
• Wait about 15 minutes after eating, drinking or smoking before an oral temperature. Axillary reads about 1°F lower than oral, rectal about 1°F higher.
• Count an irregular pulse for a full minute, and count respirations right after the pulse with your fingers still on the wrist.
• Objective is what you see, hear, smell, feel or measure; subjective is what the client tells you. Record subjective complaints in the client's own words.
• Report immediately: sudden confusion, chest pain, trouble breathing, bluish lips, a fall, black tarry stool. Routine changes are recorded and reported in the normal way.

Questions and answers, explained

All 5 questions above, with the correct answer and why it is correct. Everything here is on observation, vital signs and reporting.

1. A client says, "My chest feels tight." How should the aide record this?

   • AClient has a heart problem
   • BClient is exaggerating again
   • CClient states, "My chest feels tight."Correct
   • DClient seemed anxious about nothing

   Why: Record what the client said in their own words, without diagnosing or judging. Chest tightness is also something the aide reports to the nurse right away, and the aide may need to call 911 per agency policy if it is severe or comes with other warning signs.

   Reference Documentation standards

2. For a client with heart failure, which weight change is commonly reported to the nurse right away?

   • AA gain of 2 to 3 pounds in a day, or 5 pounds in a weekCorrect
   • BAny loss of half a pound over a month
   • COnly a gain of 20 pounds or more, since smaller changes are just water
   • DWeight changes never matter in heart failure

   Why: Rapid weight gain in heart failure usually means fluid is building up, before swelling or shortness of breath become obvious. A common reporting threshold is 2 to 3 pounds in a day or 5 pounds in a week, unless the care plan sets a different number.

   Reference AHA heart failure self-care guidance

3. The care plan says "NPO after midnight." What does NPO mean?

   • ANo physical activity overnight
   • BGive pain medicine as needed
   • CNothing by mouthCorrect
   • DNote pulse and oxygen hourly

   Why: NPO comes from Latin for nothing by mouth: no food or drink, often before a test or procedure. Other common abbreviations: PRN means as needed, BID twice a day, TID three times a day, and q means every, as in q2h for every 2 hours.

   Reference Common medical abbreviations

4. The aide notices the client's lips and nail beds look bluish. What does this suggest?

   • AThe client is cold from the air conditioning only
   • BThe client may not be getting enough oxygenCorrect
   • CThe client has eaten blueberries recently
   • DThe client's blood sugar is too high

   Why: A bluish color (cyanosis) of the lips, nail beds or skin can mean low oxygen in the blood. It is reported immediately, and if the client is also struggling to breathe, the aide follows the agency's emergency procedure and calls 911.

   Reference 42 CFR 484.80(b)(3)(v), (vii)

5. Which visit note is written correctly?

   • AClient was in a bad mood and difficult all day
   • BClient seems to be getting dementia, I think
   • CClient refused lunch; ate 2 crackers and drank 4 oz juiceCorrect
   • DClient was fine, everything normal as usual

   Why: Good notes are objective, specific and measurable: what was offered, what was eaten, exact amounts. Labels like 'difficult', guesses about diagnoses, and vague phrases like 'everything normal' give the nurse nothing to act on.

   Reference Documentation standards

Topics inside this domain

• HHA vital signs: normal ranges and how to measure them
• Dementia care for home health aides: communication that works

Drill other domains

• Role, Responsibilities and Ethics (15%)
• Personal Care and Hygiene (13%)
• Mobility, Transfers and Positioning (9%)
• Nutrition and Fluids (5%)
• Infection Control (7%)
• Safety and Emergencies (7%)

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