A nurse is planning to use the SBAR communication tool when giving on coming shift report. Which of the following statements should the nurse include in the R step?
"There are no provider's prescriptions available."
"The client should be seen by a neurologist."
"The client is disoriented. Pupils are slow to respond to light."
"The client was found unconscious on the floor in her home."
The Correct Answer is B
A. "There are no provider's prescriptions available." This statement is about the current situation or background, not a recommendation.
B. "The client should be seen by a neurologist." The Recommendation (R) step involves suggesting actions or solutions, such as recommending that the client be seen by a neurologist.
C. "The client is disoriented. Pupils are slow to respond to light." This statement belongs in the Assessment (A) step as it describes the nurse’s clinical findings.
D. "The client was found unconscious on the floor in her home." This statement provides background information (B) about the client’s situation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. A patient who needs help with bathing: Nursing assistants are trained to assist with activities of daily living (ADLs), such as bathing.
B. A post-op laparotomy patient who needs education. Education and postoperative teaching require the skills and knowledge of a licensed nurse.
C. A newly admitted patient with a seizure disorder. Newly admitted patients with complex conditions need thorough assessment and monitoring by a licensed nurse.
D. A dehydrated patient with an electrolyte imbalance. Managing dehydration and electrolyte imbalances requires clinical judgment and interventions that should be handled by a licensed nurse.
Correct Answer is A
Explanation
A. Clarification: Clarification is a technique used to ensure that the nurse understands the client’s feelings and concerns correctly. By asking if the client is feeling anxious about the results, the nurse is clarifying the client’s statement.
B. Providing information: Providing information involves giving facts or details to the client, not seeking to understand their feelings.
C. Confrontation: Confrontation involves addressing discrepancies in the client’s statements or behaviors, which is not applicable in this situation.
D. Summarizing: Summarizing involves reviewing main points of the conversation, not clarifying feelings.
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