Which set of vital signs, taken on an adult, is cause for concern and requires further evaluation?
Temperature 96.9°F; pulse 100 bpm; respirations 20 breaths/minute; blood pressure 120/80 mmHg.
Temperature 97.0°F; pulse 54 bpm; respirations 14 breaths/minute; blood pressure 196/114 mmHg.
Temperature 98.6°F; pulse 60 bpm; respirations 14 breaths/minute; blood pressure 110/66 mmHg.
Temperature 99°F; pulse 72 bpm; respirations 16 breaths/minute; blood pressure 100/60 mmHg.
The Correct Answer is B
Temperature 97.0°F; pulse 54 bpm; respirations 14 breaths/minute; blood pressure 196/114 mmHg.
This set of vital signs is cause for concern because the blood pressure is significantly elevated.
A blood pressure reading of 196/114 mmHg is considered a hypertensive crisis and requires immediate medical attention.
Choice A) Temperature 96.9°F; pulse 100 bpm; respirations 20 breaths/minute; blood pressure 120/80 mmHg is within normal limits for an adult.
Choice C) Temperature 98.6°F; pulse 60 bpm; respirations 14 breaths/minute; blood pressure 110/66 mmHg is also within normal limits for an adult.
Choice D) Temperature 99°F; pulse 72 bpm; respirations 16 breaths/minute; blood pressure 100/60 mmHg is slightly elevated but not cause for immediate concern.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
This scenario is an example of cultural imposition.
Cultural imposition is when one person or group imposes their beliefs, values, and practices on another person or group.
Choice B is not an answer because cultural competency involves understanding and respecting the beliefs, values, and practices of different cultures.
Choice C is not an answer because stereotyping involves making assumptions about a person or group based on preconceived notions or generalizations.
Choice D is not an answer because racism involves discrimination or prejudice against a person or group based on their race.
Correct Answer is ["A","B","E"]
Explanation
CHOICE A. It is important to identify yourself when interacting with a client with a visual impairment so that they know who they are speaking with.
CHOICE B. Ensuring adequate lighting can help the client to see better and make use of any remaining vision they may have [B].
CHOICE E. Providing discharge instructions in large print can make it easier for the client to read and understand the information
CHOICE C. Speaking louder is not necessary for clients with visual impairments unless they also have a hearing impairment
CHOICE D. Avoiding talking to other people in the room is not necessary and may make the client feel excluded from the conversation
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