A nurse is giving change-of-shift report using SBAR to the oncoming nurse on a client who has a traumatic brain injury. Which of the following information should the nurse include in the background segment of SBAR?

Glasgow results

Intracranial pressure readings

Code status

Plan of care changes for upcoming shift

Answer and Explanation

The Correct Answer is B

A. Glasgow results: This information would typically be included in the "Assessment" section of SBAR, as it relates to the current status of the client.

B. Intracranial pressure readings: This information is appropriate for the "Background" segment of SBAR as it provides relevant context about the client's condition that could impact the plan of care.

C. Code status: This information should be included in the "Background" section if it is relevant to the client's overall care and treatment plan, but it is not specific to the immediate context of the traumatic brain injury.

D. Plan of care changes for upcoming shift: This information belongs in the "Recommendation" or "Plan" section of SBAR, as it involves the actions or changes planned for the client’s care during the upcoming shift.

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Correct Answer is A

Explanation

A. Collect and organize client data: The first step in the nursing process involves gathering and organizing data about the clients, which is essential for making informed decisions and planning care.

B. Critically analyze client data to determine priorities: Analysis of data and setting priorities come after the initial collection and organization of client data.

C. Determine effectiveness of interventions: Evaluating the effectiveness of interventions occurs after implementing the care plan and is not the first step in the process.

D. Set client-centered, measurable and realistic goals: Goal-setting follows the collection and analysis of data and is part of the planning phase in the nursing process.

A. Atorvastatin B. Telmisartan C. Duloxetine D. Furosemide E. Clopidogrel

Correct Answer is ["B","C","D"]

Explanation

A. Atorvastatin: This medication is used to manage cholesterol levels and is not typically associated with orthostatic hypotension.
B. Telmisartan: This angiotensin II receptor blocker (ARB) can cause orthostatic hypotension, especially when starting or adjusting the dose of the medication.
C. Duloxetine: This serotonin-norepinephrine reuptake inhibitor (SNRI) may contribute to orthostatic hypotension, particularly in older adults.
D. Furosemide: This diuretic can lead to orthostatic hypotension due to its effect on fluid balance and blood pressure.
E. Clopidogrel: This antiplatelet medication does not generally cause orthostatic hypotension.

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A nurse is giving change-of-shift report using SBAR to the oncoming nurse on a client who has a traumatic brain injury. Which of the following information should the nurse include in the background segment of SBAR?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is receiving change-of-shift report for a group of assigned clients. The nurse anticipates which of the following activities first in delivering client care using the nursing process?

Correct Answer is A

Explanation

A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.)

Correct Answer is ["B","C","D"]

Explanation

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