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CMSA: Vital Signs and Patient Assessment

CMSA · Work through your exam, one topic at a time.

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Vital Signs and Patient Assessment

What the domain tests

Vital Signs and Patient Assessment covers measurement technique, normal ranges, and the response to an abnormal value. Expect questions about cuff size, counting respirations, orthostatic blood pressure, and pain as the fifth vital sign.

Core rules

  • Adult resting ranges: oral temperature about 36.5-37.5 C (97.7-99.5 F); pulse 60-100 beats/min; respirations 12-20/min; blood pressure below 120/80 mmHg; SpO2 95-100% on room air.
  • Count respirations for 30 seconds and multiply by two, using a full minute if irregular. Do not announce that you are counting, because awareness alters the rate.
  • Blood pressure: patient seated quietly five minutes, feet flat, back supported, arm at heart level, correct cuff size (bladder encircles about 80% of the arm), no caffeine, exercise, or smoking for 30 minutes.
  • Orthostatic vitals: measure lying, then after standing one to three minutes. A drop of 20 mmHg systolic or 10 mmHg diastolic with symptoms indicates orthostasis.
  • Pulse oximetry needs a warm, well-perfused site; anemia, poor circulation, dark nail polish, and motion can distort readings. It reflects oxygen saturation, not ventilation.
  • Assess pain with a consistent scale (0-10 numeric, Wong-Baker FACES for children) and record location, quality, and effect on function.
  • Temperature routes differ: rectal is closest to core, axillary is least accurate, and oral, tympanic, and temporal each have caveats. Document the route used.
  • Older adults often mount a blunted febrile response, and pediatric ranges vary by age.

Worked example

A patient's blood pressure reads 148/92. Reasoning: one elevated reading does not establish hypertension. Confirm cuff size and arm position, allow five minutes of rest, and repeat in the same arm. If the value remains elevated, report it to the provider. Repeating immediately without correcting technique, or telling the patient she has hypertension, is wrong.

Traps that cost marks

  • Using a cuff that is too small, which falsely raises the reading.
  • Counting respirations aloud or telling the patient, altering the rate.
  • Accepting a normal SpO2 in a patient breathing rapidly and shallowly.
  • Documenting an estimated value instead of a measured one.