Sharpen Your Clinical Judgment with the REx-PN

A rapid drop in oxygen saturation from 96% to 88% indicates acute respiratory deterioration and requires immediate assessment. This is a priority because it signals a potentially life-threatening change. Option A describes a mildly elevated fasting glucose within a range that does not require urgent intervention. Option C is a comfort need that can be addressed shortly after the urgent assessment. Option D shows a modest weight gain that warrants monitoring but is not immediately dangerous.

Ibuprofen is an NSAID that inhibits platelet aggregation and can significantly increase the risk of bleeding when taken with warfarin. This statement indicates the client needs further education. Option A is correct — INR monitoring is essential for warfarin therapy (therapeutic range is typically 2.0–3.0). Option B is correct — consistency in vitamin K intake is key. Option D is correct — electric razors reduce the risk of cuts for clients on anticoagulants.

According to the Kübler-Ross model, the bargaining stage is characterized by the client making deals or expressing “if only” statements. The client is negotiating for more time in exchange for a specific milestone. Option A (denial) would present as refusing to believe the diagnosis. Option B (anger) might present as lashing out or questioning “why me?” Option D (depression) would present as withdrawal, sadness, or hopelessness.

A pre-meal blood glucose of 4.8 mmol/L is at the lower end of normal (4.0–7.0 mmol/L fasting). Administering rapid-acting insulin at this level could cause hypoglycemia (below 4.0 mmol/L). The nurse should hold the insulin, notify the prescriber, and document the reading. Option A risks hypoglycemia. Option C — nurses should not independently adjust insulin doses without orders. Option D ignores the risk of giving insulin when glucose is borderline low.

Contact Precautions for C. difficile require a gown and gloves. C. difficile is transmitted via direct contact with the infected person or contaminated surfaces through spores, not airborne droplets, so a mask is not required. Hand hygiene for C. diff requires soap and water (alcohol does not kill spores). Option A N95 is for Airborne Precautions (e.g., TB). Option B includes an unnecessary mask. Option D is insufficient a gown protects clothing from contamination.