A nurse is caring for a client whose blood pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is best?

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Question 1 of 5

A nurse is caring for a client whose blood pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is best?

Correct Answer: A

Rationale: The Rapid Response Team (RRT) intervenes for deteriorating clients to prevent arrest, making it the best action for a significant blood pressure drop. Documentation (B) is necessary but insufficient alone, notifying the provider (C) is secondary to RRT, and repeating in 15 minutes (D) delays critical care.

Question 2 of 5

A nurse is using evidence-based practice (EBP) to address client care issues. Which factors does the nurse include in this process? ((Select ONE that does not apply.)

Correct Answer: A

Rationale: EBP includes nurse expertise (B), client preferences (C), research findings (D), and client values (E). Cost-saving (A) is not a core EBP component.

Question 3 of 5

A fishbone diagram is a useful tool to:

Correct Answer: A

Rationale: Fishbone diagrams (A) pinpoint root causes, unlike B, C, or D which focus elsewhere.

Question 4 of 5

Critical thinking is best defined as:

Correct Answer: C

Rationale: Critical thinking (C) is orderly and logical, unlike A (vague), B (reflective focus), or D (nursing-specific).

Question 5 of 5

Optimal group size for decision making is important because:

Correct Answer: C

Rationale: Both A and B (C) affect group effectiveness, unlike D.

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