A Nurse Reviews Vital Signs for a Patient Admitted with an Injury

question 18

Multiple Choice

A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated.The medical record shows these blood pressure and pulse readings at the times listed:
0200: $\quad$ 118/78 mm Hg and 72 beats/min
0400: $\quad$ 126/80 mm Hg and 76 beats/min
0600: $\quad$ 128/82 mm Hg and 72 beats/min
0800: $\quad$ 132/88 mm Hg and 80 beats/min
1000: $\quad$ 148/94 mm Hg and 96 beats/min
What is the nurse's priority action?

• A) Force fluids.
• B) Consult the health care provider.
• C) Obtain a clean-catch urine sample.
• D) Place the patient in a vest-type restraint.

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Definitions:

Spousal Violence

Spousal violence involves physical, sexual, psychological, or emotional abuse by one spouse or intimate partner against the other, aiming to control, intimidate, or harm.

Police-reported

Refers to incidents, crimes, or events that have been officially reported to and recorded by law enforcement agencies.

Violent Crime

Acts that involve force or threat of force against others, including assault, robbery, and homicide.

Instrumental Traits

Characteristics related to task and goal achievement, often associated with masculinity, such as assertiveness and competitiveness.