Vital Signs: Temperature, Pulse, and Respirations

Vital Signs: Temperature, Pulse, and Respirations

On the Delaware Prometric Certified Nurse Aide written exam, Domain IV: Basic Nursing Care Provided by the Nurse Aide carries about 26% of the 60-question test—roughly sixteen questions, the largest single domain weight. Vital signs sit at the center of this domain. In Delaware long-term care facilities overseen by the Division of Health Care Quality (DHCQ), the CNA is often the staff member who obtains routine temperatures, radial pulses, and respirations at the bedside. Your job is not to diagnose fever, arrhythmia, or pneumonia. Your job is to measure correctly, record honestly, notice change, and report abnormal findings to the licensed nurse without delay.

What Vital Signs Tell the Care Team

Vital signs are measurements of life-sustaining body functions. For the nurse aide exam, focus on:

Some facilities also use pulse oximetry (SpO2). Follow facility policy and report values the nurse has flagged as reportable. CNAs do not interpret trends into medical diagnoses; they supply accurate data and observations.

When to Measure

Common times include admission or readmission, shift routines per care plan, before and after certain activities, after a fall or change in condition, when the resident reports feeling unwell, and whenever the nurse orders. Wash hands before and after, explain what you will do, and clean shared equipment between residents. Privacy and dignity still apply—close the door or curtain when appropriate even for “quick” vitals.

Temperature: Routes, Ranges, and Rules

Teaching ranges for oral temperature in adults are often given as about 97.6–99.6°F (approximately 36.4–37.6°C), with 98.6°F as the classic average. Exact facility “report if” numbers may be tighter; learn your unit’s thresholds. Route matters:

When not to take an oral temperature

Do not use the oral route when the resident is unconscious, confused and cannot cooperate, seizing, mouth-breathing heavily, on oxygen by mask that blocks the mouth, has recent oral surgery or injury, or is a young child who cannot follow instructions. Wait about 15–30 minutes after hot or cold drinks, chewing gum, or smoking before oral measurement—these change mouth temperature without changing core temperature.

Fever and hypothermia clues

Report temperatures outside the expected range for that resident and route, especially with chills, sweating, flushed or pale skin, new confusion, or lethargy. A reading near or above common fever cutoffs (many programs teach about 100.4°F / 38°C as a fever threshold, but report per nurse and facility) is never “wait until the end of the shift.” Abnormally low temperature (hypothermia risk) also requires prompt nursing notification, especially in frail elders after baths or cool environments.

Radial Pulse Skill

The radial pulse is felt on the thumb side of the wrist. Delaware clinical skills testing commonly evaluates pulse and respiration measurement accuracy.

Technique

1. Explain, hand hygiene, position the resident comfortably with the arm supported.
2. Place two or three fingers (index and middle, often with ring finger) over the radial artery—never the thumb, which has its own pulse you can mistake for the resident’s.
3. Press lightly until you feel the beat; too hard obliterates the pulse.
4. If the pulse is regular, many checklists allow counting 30 seconds and multiplying by 2. If the pulse is irregular, or if the skills sheet requires a full minute, count a full 60 seconds.
5. Note rate (beats per minute), rhythm (regular or irregular), and force (strong, weak, thready, bounding).
6. Record immediately; report rates below about 60 (bradycardia teaching flag) or above about 100 (tachycardia teaching flag), irregularity that is new, or a weak pulse—along with associated signs such as dizziness, chest pain, or pale cool skin.

An apical pulse (counted with a stethoscope at the heart apex for a full minute) is used by licensed staff or per advanced assignment; know that it exists when radial is hard to feel or irregular, but stay inside your training and facility scope.

Respirations Skill

Respirations measure how many times the resident completes a breath cycle in one minute. Normal adult teaching range is about 12–20 breaths per minute at rest.

Critical skill detail: do not announce the count

If you say “I am counting your breathing now,” many people consciously change rate or depth. Standard CNA technique: after finishing the pulse (or while still holding the wrist), continue to look as if you are counting the pulse while you watch the chest or abdomen rise and fall. One rise + one fall = one respiration. Count for 30 seconds × 2 if regular and allowed, or a full 60 seconds if irregular, shallow, labored, or required by the skills checklist.

Also observe:

• Depth — shallow, normal, or deep
• Effort — easy or labored; use of neck or accessory muscles
• Sounds — wheezing, gurgling, or noisy breathing (report; do not diagnose asthma)
• Color — cyanosis (bluish lips or nail beds) is an emergency report
• Pattern — very irregular, periods of no breathing (apnea), or extreme shortness of breath (dyspnea)

Report rates outside the usual range, sudden increase with anxiety or pain, difficulty speaking full sentences, or any sign of respiratory distress immediately.

Factors That Affect Readings

Wrong technique and real physiology both change numbers. Know common factors so you can prevent error and give the nurse useful context:

If a value seems wildly wrong for the resident, recheck once carefully (same route, correct technique) and still report if it remains abnormal. Never invent a “normal” number because you fear looking slow, and never chart a value you did not actually measure.

Skills Exam Integrity and Accuracy

On Delaware Prometric clinical skills evaluation, radial pulse and respirations are high-frequency assigned skills. Evaluators compare your recorded numbers to their simultaneous count within a published accuracy range (know the tolerance your training program teaches from the Candidate Information Bulletin skill sheets). Critical failures include recording a fabricated number, failing hand hygiene or infection control, or leaving the resident unsafe. Practice with a partner until your counts match consistently.

Worked Scenario

You measure Mrs. Lopez’s radial pulse at 108 and irregular after she reports “my heart is racing.” Respirations are 24 and slightly labored. Oral temperature is 99.0°F. Correct action: stay calm, notify the licensed nurse immediately with the exact numbers, time, and symptoms; keep the resident at rest; do not leave her alone if she is distressed; do not offer leftover PRN medication from another resident. Finishing the linen cart first is wrong. Guessing “anxiety only” is wrong.

Exam Focus for Domain IV Vitals

Prometric-style items reward the aide who knows normal ranges, radial technique without the thumb, 30 × 2 vs full minute, secret respiration counting, route contraindications, and immediate report of abnormal values. When two answers both mention reporting, choose the one that includes accurate measurement first and prompt nurse notification without diagnosing or medicating.