A patient was admitted 2 days ago with pneumonia and a history of angina. The patient is now having chest pain with a pulse rate of 108. Using the SBAR, which piece of data will the nurse use for B?

Choice A reason: The statement reflects acceptance, the final Kübler-Ross stage, where patients find peace with mortality. Bargaining involves negotiating for more time or conditions, driven by fear of loss. Acceptance reduces psychological stress, calming the limbic system, unlike bargaining, which seeks to delay death, making this incorrect for the bargaining stage.

Choice B reason: This statement represents anger, the second Kübler-Ross stage, where patients question fairness, activating emotional stress responses in the amygdala. Bargaining involves making deals to postpone death, not expressing frustration. Anger increases cortisol, reflecting emotional turmoil, while bargaining seeks control, making this statement incorrect for the bargaining stage.

Choice C reason: This statement indicates denial, the first Kübler-Ross stage, where patients reject the diagnosis, avoiding psychological distress. Bargaining involves negotiating for more time, accepting the reality but seeking delays. Denial suppresses emotional processing in the brain, while bargaining engages hope, making this statement incorrect for the bargaining stage.

Choice D reason: Bargaining, the third Kübler-Ross stage, involves negotiating for more time, like living to see a milestone (e.g., grandson’s birth). This reflects psychological coping to delay death, engaging hope and emotional regulation via the prefrontal cortex. This statement perfectly aligns with bargaining’s attempt to regain control over mortality, making it correct.

Choice A reason: Using a fluorescent light source may not adequately reveal Stage I pressure ulcers in dark skin, as color changes are subtle. Natural or halogen light is preferred to detect darkening or erythema. Fluorescent light can distort pigmentation, reducing accuracy, per dermatological assessment techniques.

Choice B reason: Inspecting skin only if the Braden score indicates risk may miss early Stage I ulcers, which present as non-blanchable darkening in dark skin. Routine inspection is essential, as Braden scores predict risk but do not confirm ulcers, potentially delaying intervention, per pressure injury protocols.

Choice C reason: Avoiding touching the skin during inspection is inappropriate, as palpation detects warmth, induration, or non-blanching, key for Stage I ulcers in dark skin. Tactile assessment complements visual inspection, ensuring accurate identification of early tissue damage, per comprehensive skin assessment guidelines.

Choice D reason: Looking for skin darker than surrounding areas is the best approach for Stage I pressure ulcers in dark skin, as they present as non-blanchable hyperpigmentation rather than redness. This visual change indicates early tissue damage, guiding timely intervention to prevent progression, per pressure ulcer staging standards.