Which client scenario demonstrates hypotension requiring further assessment?

• A. A 23-year-old client who runs marathons and has a blood pressure of 82/54 mm Hg
• B. A 52-year-old client who has a fever due to a wound infection and a pulse rate of 100/min
• C. A 76-year-old client who reports moderate pain and has a respiratory rate of 20/min
• D. A 46-year-old client who is postoperative following a hysterectomy and has an SaO2 of 95%

Answer: (A)

Hypotension signals a potential problem with perfusion and requires further assessment. A systolic blood pressure as low as 82 mm Hg is out of the normal range for anyone and particularly alarming in a young, otherwise healthy runner. This level suggests possible dehydration with volume loss, heat-related illness, or a more serious issue such as internal bleeding or cardiac dysfunction. Because perfusion can deteriorate quickly, you’d want to evaluate symptoms and signs of poor perfusion (mental status changes, cool/clammy skin, delayed capillary refill), check orthostatic vitals, monitor pulse, and review recent fluid losses, wounds, or trauma, along with orders for labs and fluids as indicated.

The other scenarios don’t present with a low blood pressure. Fever with a pulse around 100 can reflect infection and tachycardia but not hypotension on its own in this description. Moderate pain with a normal respiratory rate and a postoperative patient with normal oxygen saturation indicate stable respiratory status and perfusion, not hypotension.