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Multiple Choice
In the context of homeostasis, which assessment finding by the nurse would warrant immediate action?
A
A patient with a heart rate of 72 beats per minute
B
A patient with a body temperature of 98.6°F
C
A patient with a blood pressure of 180/120 mmHg
D
A patient with a blood glucose level of 70 mg/dL
Verified step by step guidance
1
Understand the concept of homeostasis: Homeostasis refers to the body's ability to maintain a stable internal environment despite changes in external conditions. It involves the regulation of various physiological parameters such as temperature, blood pressure, and glucose levels.
Identify normal ranges for physiological parameters: A normal heart rate is typically between 60-100 beats per minute, a normal body temperature is around 98.6°F, normal blood pressure is approximately 120/80 mmHg, and normal blood glucose levels are between 70-100 mg/dL when fasting.
Evaluate each assessment finding: Compare each patient's vital sign to the normal ranges. A heart rate of 72 beats per minute and a body temperature of 98.6°F are within normal limits. A blood glucose level of 70 mg/dL is also within the normal fasting range.
Assess the blood pressure reading: A blood pressure of 180/120 mmHg is significantly higher than the normal range and indicates hypertension, which can be a medical emergency requiring immediate attention.
Determine the priority for action: Based on the comparison with normal ranges, the blood pressure reading of 180/120 mmHg is the most concerning finding and warrants immediate action to prevent potential complications such as stroke or heart attack.