In the UK, a previously alert patient is now difficult to rouse and is disorientated. The other observations are normal. How should this finding affect the NEWS2 assessment?

Correct answer: A. Record new confusion as a score of 3

  • A. Record new confusion as a score of 3
  • B. Record the patient as alert because the observations are normal
  • C. Exclude mental status because it is not a vital sign
  • D. Record confusion only if the temperature is also raised

Explanation

New confusion or a reduced level of consciousness scores 3 on NEWS2. This finding requires prompt clinical assessment and must not be overlooked because the other physiological observations are normal.

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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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