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Fundamentals · chapter 7 · Vital Signs

Teaching Patients to Perform Vital Signs

The 13 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 5 practice questions with the reasoning.

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Key points

  1. Nurse role in patient education

    Patient education is a major part of the duties of a nurse, and this sometimes includes teaching patients how to monitor their own vital signs.

  2. Reasons for self-monitoring

    There are many scenarios in which a patient may need to monitor their own vital signs, for instance, a patient is on a new heart medication, and the doctor needs to monitor the patient’s pulse and blood pressure to ensure no harmful side effects.

  3. Self-monitoring requirements

    To self-monitor their vital signs, patients need to obtain the proper equipment, learn how to use it, learn how to validate their own results, and report their results accurately to their healthcare provider.

  4. Patient learning preferences

    To teach self-monitoring, nurses first need to know how the patient best likes to learn; some people prefer to read brochures and articles, while others may prefer diagrams and pictures.

  5. Manual blood pressure equipment

    In situations where patients take manual blood pressures, they will need a properly sized cuff, a stethoscope, and a sphygmomanometer.

  6. Mercury thermometer safety

    Mercury thermometers are no longer recommended for home use due to the dangers of breaking glass and mercury poisoning.

  7. Oral temperature technique

    Patients should be instructed on proper placement of the thermometer in the mouth, under the tongue and back toward the sides of the mouth but not touching the gums. Patients should be instructed to refrain from eating or drinking anything thirty minutes prior to measuring their temperature so they do not artificially alter the reading.

  8. Pulse oximetry preparation

    Hands should be clean and dry before placing the probe on a finger without nail polish or fake nails. The patient should be seated upright and comfortably; to obtain the best reading possible, it may be helpful to instruct the patient to take a few deep, calming breaths before recording the results.

  9. Respiratory rate accuracy

    Although patients can monitor their own respiratory rate at home, it may not be as accurate as when someone else does it when the patient is not aware. Patients tend to not breathe as they naturally do if they know they have to count respiratory cycles.

  10. Blood pressure positioning

    To obtain blood pressure at home, patients must be taught proper body placement to ensure accuracy. They must sit upright with their back supported.

  11. Arm and leg placement

    The arm they will take their pressure in must be supported at heart level and bared to the upper arm. Legs must be uncrossed and feet flat on the ground.

  12. Home blood pressure readings

    Each time the patient measures their blood pressure, they should do two readings, one minute apart (American Heart Association, 2023). This is recommended in the home setting because research has shown that monitoring the average of a series of readings gives the provider more accurate information about blood pressure fluctuations and can better manage hypertension (Kumar, 2021).

  13. Reporting valid abnormalities

    Sometimes vital signs truly are abnormal, and if the patient has taken their vital signs and validated the data, they must inform their healthcare provider immediately.

Terms to know

white coat hypertension
It could be possible that the patient is unconsciously nervous when they go into the doctor’s office, thus elevating their blood pressure higher than usual, a condition known as white coat hypertension or white coat syndrome.
validate
Similar to how nurses and other healthcare providers must analyze and validate (prove the accuracy of) the vital signs data they obtain, it is important to educate patients who are taking their own vital signs at home how to analyze and validate their own numbers.
abnormal
When monitoring vital signs at home, patients should be given information regarding the normal ranges of vital signs to look for so that they can then identify results that fall out of these normal ranges (abnormal).

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. A patient who must begin home blood pressure monitoring says they do not read well and that pictures and diagrams are confusing. Which nursing action best supports this patient’s ability to self-monitor?

    1. Begin by teaching the patient to take a manual blood pressure without a machine.
    2. Use an in-person demonstration with the blood pressure machine and provide video support for review.
    3. Tell the patient to continue coming to the office because self-monitoring will be too difficult.
    4. Give the patient written brochures and ask them to review the steps at home.

    Answer: Use an in-person demonstration with the blood pressure machine and provide video support for review.

    The section emphasizes matching teaching to how the patient learns best, including videos or in-person demonstrations. Written materials or diagrams would not meet this patient’s stated learning needs, and avoiding self-monitoring does not support the purpose of patient education.

  2. The nurse is observing a patient practice taking a blood pressure at home. Which actions show correct technique? Select all that apply.

    1. Supporting the arm at heart level with the upper arm bare
    2. Crossing the legs to stay comfortable during the reading
    3. Keeping the feet flat on the ground
    4. Wrapping the correct-sized cuff snugly around the upper arm
    5. Sitting upright with the back supported

    Answer: Supporting the arm at heart level with the upper arm bare, Keeping the feet flat on the ground, Wrapping the correct-sized cuff snugly around the upper arm, Sitting upright with the back supported

    Correct home blood pressure technique includes supported upright posture, arm supported at heart level, uncrossed legs with feet flat, and a correctly sized snug cuff. Crossing the legs is incorrect because the section specifically states legs should be uncrossed.

  3. A patient asks when they should take their daily home vital signs so the readings are consistent. Which instruction is best?

    1. Take them when first getting up in the morning before eating anything.
    2. Take them only when symptoms are present.
    3. Take them at a different time each day to compare many situations.
    4. Take them immediately after eating breakfast each day.

    Answer: Take them when first getting up in the morning before eating anything.

    The section states that consistency is important, so vital signs should be taken at the same time of day every day, and identifies taking them on first getting up in the morning, before eating, as most ideal. Taking readings at varying times, after eating, or only with symptoms would reduce consistency.

  4. A patient needs to monitor respiratory rate at home and has a caregiver available. Which teaching should the nurse provide to improve accuracy?

    1. Have the patient count their own respirations while focusing on each breath.
    2. Tell the patient that respiratory rate cannot be monitored at home.
    3. Have the caregiver monitor the respiratory rate while the patient is relaxing.
    4. Instruct the patient to take a few deep breaths and then count respirations immediately.

    Answer: Have the caregiver monitor the respiratory rate while the patient is relaxing.

    The section explains that patients may not breathe naturally when they know they are counting respirations. If a family member or caregiver can monitor while the patient is relaxing, that is the better option.

  5. A patient reports an abnormal home vital sign reading. The nurse reviews how it was taken, asks about symptoms and anything different, and determines that the recorded vital sign is valid. What is the nurse’s priority action?

    1. Inform the doctor in a timely manner according to protocol.
    2. Advise the patient to ignore the reading if they feel calm.
    3. Tell the patient to stop checking vital signs at home.
    4. Document it and wait for the next routine appointment.

    Answer: Inform the doctor in a timely manner according to protocol.

    Once abnormal vital sign data are validated, the section states that the provider must be informed promptly. Waiting, stopping self-monitoring, or ignoring the reading does not follow the reporting process described in the section.

Where every quote comes from

Section 7.3 Teaching Patients to Perform Vital Signs of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.