A nurse is contacting the on-call healthcare provider about a patient who underwent a hysterectomy two days ago and is experiencing pain that is not alleviated by the prescribed opioid pain medication. Which statement constitutes the “Background” portion of the SBAR format for communication?
“I would like you to prescribe a different pain medication.”
“This patient underwent a vaginal hysterectomy two days ago.”
“The patient, D.A. Smith, has an aversion to nonsteroidal anti-inflammatory medications.”
“This patient has allergies to morphine and codeine.”
The Correct Answer is B
Choice A rationale:
This statement belongs to the "Request" portion of the SBAR format. It articulates a specific action the nurse wants the healthcare provider to take.
It's not part of the Background because it doesn't provide any historical or contextual information about the patient's condition.
Choice B rationale:
This statement is the correct choice for the "Background" portion of the SBAR format.
It provides essential background information about the patient's recent medical history, specifically the recent hysterectomy.
This information is crucial for the healthcare provider to understand the context of the current situation and make informed decisions about pain management.
Choice C rationale:
This statement provides additional patient information, but it's not the most relevant for the Background section in this context.
The patient's aversion to NSAIDs might be important for medication choices, but it doesn't directly address the current issue of pain management after a hysterectomy.
Choice D rationale:
This statement provides important information about the patient's allergies, but it's not the most relevant for the Background section in this context.
Allergies are crucial for medication safety, but they don't directly address the current issue of pain management or provide context about the patient's recent surgery.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Hyperventilation is a condition characterized by rapid and deep breathing, leading to excessive removal of carbon dioxide (CO2) from the body. This decrease in CO2 levels actually causes respiratory alkalosis, not respiratory acidosis.
CO2 is a weak acid, and its removal from the blood raises the blood pH, making it more alkaline. Key mechanisms involved in hyperventilation-induced respiratory alkalosis:
Increased alveolar ventilation: Hyperventilation increases the rate at which CO2 is expelled from the lungs, reducing its concentration in the blood.
Shift in the equilibrium of the carbonic acid-bicarbonate buffer system: The reduction in CO2 levels drives the equilibrium towards the formation of bicarbonate ions, further reducing the concentration of hydrogen ions and increasing pH.
Renal compensation: The kidneys respond to respiratory alkalosis by excreting more bicarbonate ions, which helps to normalize the blood pH.
Choice B rationale:
Asthma is a chronic respiratory disease characterized by inflammation and narrowing of the airways. This can lead to impaired ventilation and retention of CO2, which can contribute to respiratory acidosis.
Mechanisms by which asthma can cause respiratory acidosis:
Bronchoconstriction: Narrowed airways impede airflow, making it difficult to expel CO2 from the lungs.
Air trapping: Inflammation and mucus production can lead to air becoming trapped in the lungs, further increasing CO2 levels.
Hypoventilation: Severe asthma attacks can cause respiratory muscle fatigue, leading to a decrease in breathing rate and inadequate CO2 removal.
Choice C rationale:
Chronic obstructive pulmonary disease (COPD) is a group of lung diseases characterized by chronic obstruction of airflow. This obstruction can lead to impaired ventilation and retention of CO2, which can contribute to respiratory acidosis.
Mechanisms by which COPD can cause respiratory acidosis:
Emphysema: Destruction of lung tissue reduces the surface area available for gas exchange, making it difficult to expel CO2. Chronic bronchitis: Inflammation and mucus production in the airways can obstruct airflow and trap CO2 in the lungs.
Hypoventilation: COPD can lead to respiratory muscle fatigue and a decrease in breathing rate, further impairing CO2 removal.
Choice D rationale:
Pulmonary embolism (PE) is a blockage of an artery in the lungs, usually by a blood clot. This can lead to impaired gas exchange and a decrease in oxygen levels in the blood. In severe cases, PE can also cause respiratory acidosis due to inadequate CO2 removal.
Mechanisms by which PE can cause respiratory acidosis:
Ventilation-perfusion mismatch: PE obstructs blood flow to a portion of the lungs, reducing the amount of CO2 that can be removed from those areas.
Hypoxemia: Low oxygen levels in the blood can stimulate the respiratory drive, leading to hyperventilation and CO2 retention.
Right heart failure: PE can strain the right side of the heart, leading to decreased pulmonary blood flow and impaired CO2 removal.
Correct Answer is ["A","B","F","G"]
Explanation
Rationale for A: Hemoglobin and Hematocrit
Hemoglobin (Hgb) of 6.8 g/dL is significantly below the normal range of 12-16 g/dL for women and 14-18 g/dL for men. This indicates severe anemia, which can cause several of the patient's reported symptoms, including shortness of breath, fatigue, dizziness, and intolerance to cold. It's crucial to address this promptly as severe anemia can lead to tissue hypoxia and organ damage.
Hematocrit (Hct) of 21.2% is also below the normal range of 36-46% for women and 41-50% for men. Hct measures the percentage of red blood cells in the blood, and its low value further confirms the presence of anemia.
Rationale for B: Blood Pressure 100/68, Respirations 24
Blood pressure of 100/68 mmHg is considered low, especially in a patient with a history of hypertension. This could be due to the anemia, as low red blood cell count can decrease blood volume and subsequently lower blood pressure. It's essential to monitor the patient's blood pressure closely, as hypotension can lead to dizziness, fainting, and even shock.
Respirations of 24 breaths per minute are slightly elevated above the normal adult range of 12-20 breaths per minute. This could be a compensatory mechanism for the anemia, as the body tries to increase oxygen intake. However, it could also indicate other underlying respiratory issues that need to be investigated.
Rationale for F: Shortness of breath with exertion
Shortness of breath (dyspnea) is a common symptom of anemia, as the body struggles to deliver enough oxygen to tissues during physical activity. This symptom warrants immediate attention, as it can significantly impact the patient's quality of life and could potentially signal worsening anemia or other cardiopulmonary problems.
Rationale for G: Dizziness when standing
Dizziness upon standing (orthostatic hypotension) is a sign of low blood pressure, which can be exacerbated by anemia. This can increase the risk of falls and injuries, especially in a patient with other health conditions. It's crucial to address this symptom to prevent potential complications.
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