The nurse is taking vital signs on a patient with a fractured femur. The blood pressure reading is 150/96. The patient does not have a history of hypertension. What action should the nurse take next?

Choice A reason: Checking the blood pressure in 90 minutes delays addressing a potential cause of the elevated reading, such as pain from the fractured femur. Pain activates the sympathetic nervous system, increasing blood pressure. Immediate assessment of pain allows for timely intervention, preventing prolonged stress and ensuring accurate evaluation of the patient’s condition.

Choice B reason: Requesting anti-anxiety medication assumes anxiety is the cause without evidence. Pain from a fractured femur is a more likely trigger for elevated blood pressure, as it stimulates catecholamine release. Administering anxiolytics without assessing pain risks masking symptoms, delaying appropriate pain management, and failing to address the underlying physiological stressor.

Choice C reason: Requesting an antihypertensive is premature without identifying the cause of the elevated blood pressure. Pain from the fracture can cause transient hypertension via sympathetic activation. Treating the blood pressure without addressing pain may lower it unnecessarily, risking hypoperfusion while ignoring the primary issue, per pain management and cardiovascular physiology.

Choice D reason: Asking if the patient is having pain is the priority, as a fractured femur often causes significant pain, elevating blood pressure through sympathetic nervous system activation. Assessing pain guides appropriate analgesia, which may normalize blood pressure. This addresses the likely cause, aligns with patient-centered care, and prevents complications from untreated pain, per nursing assessment protocols.

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.