Very hard

In the UK, a patient has a respiratory rate of 25/min, oxygen saturation of 94% on air, systolic blood pressure of 105 mmHg, pulse of 115/min, temperature of 38.1°C and is alert. What is the most appropriate action?

Correct answer: B. Inform the nurse in charge and request an emergency response

  • A. Continue routine observations on the usual ward schedule
  • B. Inform the nurse in charge and request an emergency response
  • C. Repeat the observations in four hours without further action
  • D. Document the score and wait for the next medical ward round

Explanation

The NEWS2 score is 8: respiratory rate 25 scores 3, oxygen saturation 94% scores 1, systolic pressure 105 scores 1, pulse 115 scores 2 and temperature 38.1°C scores 1. A total score of 7 or more requires an emergency response with urgent clinical assessment.

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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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