Key Takeaways
- The five vital signs are temperature, pulse, respirations, blood pressure, and pain (sometimes oxygen saturation is considered the 6th)
- Normal adult vital signs: Temperature 97.8-99.1F (36.5-37.3C), Pulse 60-100 bpm, Respirations 12-20/min, BP <120/80 mmHg
- Blood pressure should be taken with the patient seated, arm supported at heart level, using the correct cuff size (bladder should encircle 80% of the arm)
- The pulse oximeter measures SpO2 (oxygen saturation); normal is 95-100%, and <90% requires immediate intervention
- Temperature routes in order of accuracy: rectal (most accurate, +1F above oral), oral, axillary (-1F below oral), temporal, tympanic
- Height and weight are measured at each visit; BMI is calculated as weight (kg) / height (m)^2
- Pain assessment uses scales including the Numeric Rating Scale (0-10), Wong-Baker FACES (children), and FLACC (infants/non-verbal)
- Patient history includes chief complaint (CC), history of present illness (HPI), past medical history (PMH), medications, allergies, social history, and family history
- Anthropometric measurements include height, weight, BMI, waist circumference, and head circumference (infants)
Last updated: February 2026
Vital Signs & Patient Assessment
The Clinical Patient Interaction domain is the largest domain on the RMA exam at 33.8% (approximately 71 questions). Vital signs measurement and patient assessment are fundamental skills tested throughout this domain.
The Five (Six) Vital Signs
| Vital Sign | Normal Adult Range | Method |
|---|---|---|
| Temperature | 97.8-99.1°F (36.5-37.3°C) oral | Oral, tympanic, temporal, axillary, rectal |
| Pulse | 60-100 bpm | Radial (most common), apical, carotid, pedal |
| Respirations | 12-20 breaths/min | Observe chest rise/fall (without patient awareness) |
| Blood Pressure | <120/80 mmHg | Brachial artery with sphygmomanometer and stethoscope |
| Pain | 0 (no pain) | Numeric scale (0-10), FACES, FLACC |
| Oxygen Saturation (SpO2) | 95-100% | Pulse oximeter (finger, ear, toe) |
Temperature
Routes and Normal Ranges
| Route | Normal Range | Accuracy | Notes |
|---|---|---|---|
| Rectal | 99.6°F (37.6°C) | Most accurate | +1°F above oral; used for infants, unconscious patients |
| Oral | 98.6°F (37°C) | Standard reference | Wait 15 min after eating/drinking; sublingual placement |
| Axillary | 97.6°F (36.4°C) | Least accurate | -1°F below oral; safest, used when other routes unavailable |
| Tympanic | 98.6°F (37°C) | Good accuracy | Quick reading; gently tug ear up/back (adults), down/back (children <3) |
| Temporal | 98.6°F (37°C) | Good accuracy | Non-invasive; sweep across forehead |
Temperature Terminology
| Term | Definition |
|---|---|
| Febrile | Having a fever (>100.4°F / 38°C) |
| Afebrile | Without fever |
| Hyperthermia | Abnormally high body temperature |
| Hypothermia | Abnormally low body temperature (<95°F / 35°C) |
Pulse
Pulse Sites
| Site | Location | Use |
|---|---|---|
| Radial | Wrist (thumb side) | Most common for routine measurement |
| Apical | Left side of chest, 5th intercostal space, midclavicular line | Most accurate; used for infants, irregular rhythms, cardiac patients |
| Carotid | Side of neck | Emergency assessment; do not check both sides simultaneously |
| Brachial | Inner arm above elbow | Blood pressure assessment; infant CPR pulse check |
| Pedal (dorsalis pedis) | Top of foot | Peripheral circulation assessment |
| Femoral | Groin (inguinal area) | Emergency assessment |
| Popliteal | Behind the knee | Lower extremity circulation |
Pulse Assessment
- Count for 30 seconds and multiply by 2 (regular pulse) or 60 seconds (irregular pulse)
- Assess rate (bpm), rhythm (regular/irregular), and quality (bounding, weak, thready)
- Tachycardia: >100 bpm; Bradycardia: <60 bpm
- Apical-radial pulse: Simultaneously count apical and radial pulses -- the difference is called the pulse deficit
Blood Pressure
Proper Technique
- Patient should be seated for at least 5 minutes before measurement
- Arm should be supported at heart level on a table or armrest
- Apply cuff to bare upper arm, 1 inch above the antecubital space
- Cuff bladder should encircle 80% of the arm circumference (correct sizing is critical)
- Palpate the brachial artery and place stethoscope over it
- Inflate cuff 20-30 mmHg above the estimated systolic pressure
- Deflate at 2-3 mmHg per second
- First Korotkoff sound = systolic pressure; last Korotkoff sound (disappearance) = diastolic pressure
Factors Affecting Blood Pressure
| Factor | Effect |
|---|---|
| Cuff too small | Falsely HIGH reading |
| Cuff too large | Falsely LOW reading |
| Arm above heart level | Falsely LOW reading |
| Arm below heart level | Falsely HIGH reading |
| Recent exercise/caffeine | Temporarily HIGH |
| Crossed legs | Falsely HIGH reading |
| Talking during measurement | Falsely HIGH reading |
Pain Assessment
Pain Scales
| Scale | Population | Description |
|---|---|---|
| Numeric Rating Scale (NRS) | Adults, verbal patients | Rate pain 0-10 (0=no pain, 10=worst possible) |
| Visual Analog Scale (VAS) | Adults | Mark pain level on a 10 cm line |
| Wong-Baker FACES | Children (3+), language barriers | Choose from 6 facial expressions (smiling to crying) |
| FLACC | Infants, non-verbal patients | Face, Legs, Activity, Cry, Consolability (0-2 each, total 0-10) |
OLDCARTS Pain Assessment Mnemonic
| Letter | Question |
|---|---|
| O | Onset -- When did the pain start? |
| L | Location -- Where is the pain? |
| D | Duration -- How long does it last? |
| C | Characteristics -- What does it feel like? (sharp, dull, burning, throbbing) |
| A | Aggravating factors -- What makes it worse? |
| R | Relieving factors -- What makes it better? |
| T | Timing -- Is it constant or intermittent? |
| S | Severity -- Rate on a scale of 0-10 |
Patient History Components
| Component | Content |
|---|---|
| Chief complaint (CC) | Primary reason for the visit in the patient's own words |
| History of present illness (HPI) | Detailed description of current symptoms (onset, duration, severity, etc.) |
| Past medical history (PMH) | Previous illnesses, surgeries, hospitalizations, chronic conditions |
| Medications | Current prescription and OTC medications, doses, frequency |
| Allergies | Drug allergies AND reactions (rash, anaphylaxis, nausea) |
| Social history (SH) | Smoking, alcohol, drug use, occupation, exercise, diet |
| Family history (FH) | Health conditions in immediate family members (heart disease, cancer, diabetes) |
| Review of systems (ROS) | Systematic questioning about each body system |
Physical Examination Positions
| Position | Description | Used For |
|---|---|---|
| Sitting | Upright on exam table | Head, eyes, ears, nose, throat, chest, heart, lungs |
| Supine | Lying face up, flat | Abdominal exam, breast exam |
| Prone | Lying face down | Back exam, posterior examination |
| Dorsal recumbent | Supine with knees bent, feet flat | Abdominal, vaginal exam |
| Lithotomy | Supine with feet in stirrups, legs apart | Pelvic exam, Pap smear |
| Sims' (left lateral) | Left side, left arm behind, right knee bent | Rectal exam, enema, sigmoidoscopy |
| Knee-chest | Kneeling with chest on table | Rectal/sigmoid exam |
| Fowler's | Semi-upright (head elevated 45-60°) | Breathing difficulty, post-surgical |
| Trendelenburg | Supine with feet higher than head | Shock, low blood pressure |
Test Your Knowledge
A medical assistant takes a patient's blood pressure using a cuff that is too small for the patient's arm. This will most likely result in:
A
B
C
D
Test Your Knowledge
Which temperature route is considered the MOST accurate?
A
B
C
D
Test Your Knowledge
Normal adult respiratory rate is:
A
B
C
D
Test Your Knowledge
When measuring blood pressure, the first Korotkoff sound heard represents the:
A
B
C
D
Test Your Knowledge
A pulse oximeter reading of 88% on a patient indicates:
A
B
C
D
Test Your KnowledgeFill in the Blank
The most common site for routine pulse measurement in adults is the ___ artery.
Type your answer below
Test Your KnowledgeMatching
Match each examination position with its primary use.
Match each item on the left with the correct item on the right
1
Lithotomy
2
Sims (left lateral)
3
Trendelenburg
4
Fowler's
5
Prone
Test Your KnowledgeMulti-Select
Which of the following factors can cause a falsely ELEVATED blood pressure reading? (Select all that apply)
Select all that apply
Cuff too small for the patient's arm
Arm positioned above heart level
Patient talking during measurement
Patient's legs crossed
Cuff too large for the patient's arm
Recent exercise or caffeine intake