In the UK, a nurse records a rising respiratory rate and pulse but the patient's NEWS2 score remains below the escalation threshold. What is the best next step?
Correct answer: A. Compare the trend, reassess the patient and escalate concern if needed
- A. Compare the trend, reassess the patient and escalate concern if needed
- B. Ignore the changes because the current total is below the threshold
- C. Remove the patient from observations to reduce unnecessary interventions
- D. Wait for the next shift to decide whether the trend is important
Explanation
A rising trend may indicate early deterioration even when the current NEWS2 total is below an escalation threshold. The nurse should reassess the patient, review previous observations and escalate using clinical judgement and SBAR when concerned.
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About Recognising Deterioration, NEWS2 and SBAR
Recognising deterioration involves trends in respiratory rate, oxygen saturation, blood pressure, pulse, temperature, consciousness and urine output, together with clinical concern. NEWS2 scoring, its oxygen scale and escalation thresholds support structured response, while SBAR communicates the situation, background, assessment and recommendation; NEWS2 supports judgement but does not replace bedside assessment or urgent action.
Practise Recognising Deterioration, NEWS2 and SBAR
50 free Recognising Deterioration, NEWS2 and SBAR MCQs from International Nursing Practice, each with the correct answer and an explanation. Unlimited attempts, no account needed.
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