A nurse is preparing to provide a change-of-shift report. Using the SBAR communication technique, which of the following client information should the nurse include in the "A" portion of the report?

"The client is 2 hours postoperative following a cholecystectomy."

"The client rates her pain at a 3 on a 0 to 10 pain rating scale."

"The client has type 2 diabetes mellitus."

"The client should wear compression stockings."

Answer and Explanation

The Correct Answer is B

A.   "The client is 2 hours postoperative following a cholecystectomy." This belongs in the "B" (Background) section since it provides historical or procedural information.
B.   "The client rates her pain at a 3 on a 0 to 10 pain rating scale." This is part of the "A" (Assessment) portion as it involves the nurse's evaluation of the client's current condition.
C.   "The client has type 2 diabetes mellitus." This is background information relevant to the client's medical history and should be included in the "B" section.
D.   "The client should wear compression stockings." This is part of the "R" (Recommendation) section as it involves future care instructions.

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Correct Answer is A

Explanation

A. Advance directives: Advance directives may contain information about the client's wishes for organ donation, along with other end-of-life preferences.
B. Informed consent: Informed consent is related to specific treatments or procedures and does not address organ donation.
C. Provider's prescription: Providers do not write prescriptions for organ donation; it is a legal decision made by the client.
D. Do-not-resuscitate (DNR) order: A DNR order only indicates that no resuscitation should be attempted in the event of cardiac or respiratory arrest.

A. Select the appropriate dressing. B. Document the dressing change. C. Change the dressing. D. Review available dressing types.

Correct Answer is D

Explanation

A. Select the appropriate dressing: Although selecting the right dressing is essential, it is not the initial step.
B. Document the dressing change: Documentation follows the intervention, not precedes it.
C. Change the dressing: Performing the dressing change without adequate preparation is not the first step.
D. Review available dressing types: Reviewing available dressing options ensures appropriate selection based on the wound's condition and treatment goals.

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A nurse is preparing to provide a change-of-shift report. Using the SBAR communication technique, which of the following client information should the nurse include in the "A" portion of the report?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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Correct Answer is D

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