A nurse is giving change-of-shift report using the SBAR technique about a client who has a traumatic brain injury. When reporting information about the client, which of the following should the nurse include in the situation segment of SBAR?

Glasgow coma scale result

History of the injury

Medication during the next shift

Intracranial pressure readings

Answer and Explanation

The Correct Answer is B

Explanation:

A. Glasgow coma scale result - This would be included in the assessment segment of SBAR, as it provides a clinical evaluation of the client's current neurological status.

B. History of the injury - The situation segment is used to briefly explain the current situation or the reason for the report. Including the history of the injury provides context about why the client is receiving care.

C. Medication during the next shift - This information is part of the Recommendation segment of SBAR. The nurse should include any upcoming medication administration, changes in medication orders, or specific medications that need to be administered during the next shift.

D. Intracranial pressure readings - This information should be included in the Assessment segment of SBAR. It provides important data about the client's intracranial status, helps monitor for changes or trends, and guides ongoing management and interventions.

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Correct Answer is B

Explanation

Explanation:

A. Expert opinions:

Expert opinions are valuable in clinical practice and decision-making, but they are considered a lower level of evidence compared to systematic reviews and meta-analyses. Expert opinions are often classified as Level V evidence in the hierarchy.

B. Systematic review

A systematic review is a comprehensive and rigorous synthesis of multiple studies on a particular topic, and it often includes a meta-analysis that statistically combines the results of these studies to provide a high level of evidence. This type of evidence is considered Level I because it provides a strong foundation for making clinical decisions due to its methodological rigor and ability to summarize findings from multiple studies.

C. Credible websites:

Credible websites can provide valuable information, but they are not classified as Level I evidence. The evidence hierarchy typically places systematic reviews and meta-analyses at the highest level due to their methodological rigor and synthesis of multiple studies.

D. Qualitative studies:

Qualitative studies are valuable for exploring complex phenomena and understanding individuals' experiences, beliefs, and perspectives. However, they are generally considered lower in the hierarchy of evidence compared to systematic reviews and RCTs, which are categorized as Level I evidence.

A. A preschooler who has a BMI indicating obesity B. A school-age child who cries when the nurse is giving him an injection C. An adolescent who asks to stay in the hospital because he likes the room D. A toddler who has multiple bruises on the shins of both legs and his parents report that he is clumsy

Correct Answer is C

Explanation

A.While childhood obesity is a health concern, it is not a specific indicator of abuse. Obesity can result from dietary habits, lack of physical activity, or medical conditions.

B.Fear of injections is common in children and is a typical developmental response. Crying during an injection is not an indicator of abuse and is expected behavior for many children.

C.While this finding alone does not confirm abuse, it may indicate an underlying issue in the adolescent's home environment. It requires further exploration through careful, open-ended questioning to assess for potential emotional or physical abuse or neglect.

D.Bruising on the shins of toddlers is common due to normal play and falls during development. The explanation provided by the parents aligns with typical toddler behavior and does not raise immediate concerns for abuse unless the bruises are in unusual locations (e.g., abdomen, back, or thighs).

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A nurse is giving change-of-shift report using the SBAR technique about a client who has a traumatic brain injury. When reporting information about the client, which of the following should the nurse include in the situation segment of SBAR?

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Naxlex Comprehensive Predictor Exams

A charge nurse is discussing evidence-based practice (EBP) and the hierarchy of evidence with a newly licensed nurse. Which of the following examples should the nurse provide when discussing Level I evidence?

Correct Answer is B

Explanation

A nurse on a medical-surgical unit is caring for a group of children. Which of the following findings should alert the nurse that one of the children is a potential victim of abuse?

Correct Answer is C

Explanation

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