An assistive personnel (AP) reports the following vital signs for your patient: temperature 98.8 F, pulse 92/min, respiratory rate 18/min, and BP 98/58 mm Hg. Which of the following vital signs should the nurse re-measure?

Choice A rationale The reported pulse rate of 92 beats per minute falls within the expected reference range for a healthy adult, which is typically between 60 and 100 beats per minute. Because this value is hemodynamically stable and normal, there is no immediate physiological indication that the nurse needs to re-measure it. The AP's finding is consistent with a resting state, and unless the patient is symptomatic or has a specific cardiac history, this measurement is accepted. Choice B rationale The respiratory rate of 18 breaths per minute is within the normal adult range of 12 to 20 breaths per minute. This finding indicates that the patient is likely ventilating adequately without acute distress. Since the value is not tachypneic or bradypneic, re-measurement is not a priority. The nurse should continue to observe the patient's work of breathing and oxygen saturation, but the reported rate itself does not necessitate an immediate verification by the licensed nurse. Choice C rationale The reported blood pressure of 98/58 mm Hg is considered low, as a typical normal reading is approximately 120/80 mm Hg. Hypotension, generally defined as a systolic pressure below 90 mm Hg or a significantly low diastolic pressure, requires professional verification to ensure patient safety and clinical accuracy. The nurse must assess for signs of decreased organ perfusion, such as dizziness or confusion, and confirm the reading before making interventions or notifying the provider about the status. Choice D rationale A temperature of 98.8 F is well within the normal afebrile range for an adult, which usually spans from 96.4 F to 99.1 F. Since this reading does not indicate a fever or hypothermia, there is no clinical reason to doubt the AP's measurement or to perform a repeat assessment. The patient’s thermoregulation appears intact, and the nurse can move on to addressing more concerning vital signs, such as the low blood pressure reported in the set.