A nurse is caring for a 68-year-old patient who recently immigrated from Vietnam and practices traditional healing methods. The patient has been hospitalized twice in the past month for uncontrolled hypertension.
During assessment, the nurse learns the patient stopped taking prescribed antihypertensive medication because it caused dizziness and instead has been using herbal remedies recommended by a community healer. Which actions by the nurse best promote quality and safety? (Select all that apply.)

Choice A rationale

The patient exhibiting chest pain radiating to the left arm accompanied by diaphoresis is demonstrating classic symptoms of an acute myocardial infarction. This represents a life-threatening circulatory emergency that requires immediate assessment and intervention to prevent cardiac muscle necrosis. Using the airway, breathing, and circulation priority framework, this patient is the most unstable. Prompt evaluation is critical to initiate emergency protocols, such as administering oxygen, nitroglycerin, or obtaining an electrocardiogram to identify cardiac ischemia.

Choice B rationale

Although a pain rating of 9/10 is significant and requires timely intervention, pain is generally considered a psychosocial or physiological priority that falls below immediate life-threatening circulatory or airway issues. The nurse must address the pain after assessing more unstable patients. While postoperative hip replacement patients are at risk for complications, the acute symptoms of a potential heart attack in another patient take precedence over musculoskeletal pain management in a stable postoperative patient.

Choice C rationale

A blood glucose level of 260 mg/dL is elevated, as the normal fasting range is typically 70 to 99 mg/dL. While this requires the administration of insulin per sliding scale or provider orders, it does not constitute an immediate life-threatening emergency like a myocardial infarction. Chronic hyperglycemia is serious but lacks the urgency of acute chest pain. The nurse should check on this patient after addressing higher-priority respiratory or circulatory distress to prevent diabetic ketoacidosis or other complications.

Choice D rationale

For a patient with chronic obstructive pulmonary disease, an oxygen saturation of 92 percent is often within the expected target range, as these patients often compensate for chronic hypercapnia. While the patient is short of breath, this is a common baseline finding for their condition. Unless the oxygen saturation drops significantly below their personal baseline or 90 percent, they are considered more stable than a patient experiencing active cardiac ischemia. This patient requires monitoring but not the highest priority.

Choice A rationale

Appraising the evidence involves a systematic evaluation of clinical research to determine its reliability, validity, and applicability to a specific patient population. While this step is essential for ensuring that only high-quality data informs nursing practice, it cannot occur until a specific question has been formulated and relevant studies have been gathered. Appraisal is a middle stage in the evidence-based practice process rather than the initial starting point for the manager.

Choice B rationale

Identifying appropriate databases, such as CINAHL or PubMed, is a technical step in the search process used to locate relevant literature. Although selecting the right tools is necessary for a comprehensive search, the search itself must be directed by a specific clinical query. Without first defining the scope of the problem regarding ventilator-associated pneumonia, the nurse manager would lack the necessary parameters to conduct an efficient or focused search within these electronic databases.

Choice C rationale

Integrating available evidence with clinical expertise and patient preferences represents the implementation phase of evidence-based practice. This step occurs after the evidence has been searched, appraised, and deemed appropriate for the clinical setting. The nurse manager uses this phase to translate research findings into actual bedside interventions. Since this involves the application of already gathered knowledge, it is a later stage in the process and not the critical first step.

Choice D rationale

Developing a clinical question, often using the PICO format, is the foundational step in the evidence-based practice process. This involves identifying the population, intervention, comparison, and outcome of interest. By clearly defining the clinical ask, the nurse manager establishes the framework for the entire search and appraisal process. Without a well-structured question regarding the prevention of pneumonia, the subsequent search for evidence would be disorganized and likely fail to yield specific, actionable results.