Reduction of Risk PotentialQuestion 1470 of 2368
A client with a urinary tract infection has a temperature of 38.6 C, a heart rate of 98, a respiratory rate of 18, and a white blood cell count of 9,000. What should the nurse do?
- Continue routine monitoring because only one indicator is abnormal
- Recheck the vital signs in four hours before reporting
- Document the findings as expected for an infection
- Notify the provider immediately because two SIRS indicators are present
Show answer
Correct answer: Notify the provider immediately because two SIRS indicators are present
Temperature above 38 C and heart rate above 90 are two SIRS indicators. Two or more indicators need immediate provider notification.
Source: Nursing Fundamentals, 2nd edition (Open RN, Chippewa Valley Technical College, 2024), Infection: Implementing Interventions. Licensed under CC BY 4.0.
Practice the topic "Reduction of Risk Potential"Questions last reviewed: 18 October 2026