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 ["250"]

Explanation

Infusion rate (mL/hr) = Volume to be infused (mL) / Time (hr)

In this case:

Volume to be infused = 2000 mL
Time = 8 hours

Plugging the values into the formula:

Infusion rate = 2000 mL / 8 hours = 250 mL/hr

Answer= 250mL/hr

A. I will check your medication order again. B. Sometimes the same pill comes in a different color. C. Let me explain the purpose of the medication. D. This is the medication that your doctor wants you to take.

Correct Answer is A

Explanation

A. I will check your medication order again: This response addresses the client's concern by verifying that the medication is correct and reassures the client by ensuring that the prescribed medication matches their expectation.

B. Sometimes the same pill comes in a different color: While this might be true, this response does not directly address the client’s concern about the specific medication they are supposed to take.

C. Let me explain the purpose of the medication: This response is helpful but does not address the client's concern about the discrepancy in the medication's appearance.

D. This is the medication that your doctor wants you to take: This response may not resolve the client's concern about the pill's color and does not involve verifying the medication’s accuracy.

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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 preparing to administer 0.45% sodium chloride (NaCl) 2000 mL IV to Infuse over 8 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["250"]

Explanation

A nurse is administering an oral medication to an older adult client. The client states, "The pill I always take is green. I don't take an orange pill." Which of the following responses should the nurse make?

Correct Answer is A

Explanation

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