A nurse is preparing to provide report on a client using the Situation-Background- Assessment-Recommendation (SBAR) Communication tool.
Identify the order in which the nurse should give report.
Provide a brief description of the client’s diagnosis.
Discuss suggestions for continuing the client’s care.
State the client’s most recent vital signs.
Review the client’s pertinent medical history.
The Correct Answer is B
The nurse should give report using the SBAR Communication tool in the following order: Situation, Background, Assessment, Recommendation. This tool provides a framework for communication between members of the health care team about a patient’s condition. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team.
Choice A is wrong because it is part of the Background section of the SBAR tool, which comes after the Situation section.
Choice C is wrong because it is part of the Assessment section of the SBAR tool, which comes after the Background section.
Choice D is wrong because it is also part of the Background section of the SBAR tool, which comes after the Situation section.
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Related Questions
Correct Answer is C
Explanation
This is a manifestation of a fat embolism, which is a condition where particles of fat get into the bloodstream and block blood flow. A fat embolism can occur after trauma or surgery to the legs, when fat from the bone marrow escapes into the bloodstream.
Choice A is wrong because a report of pain as 6 on a scale of 0 to 10 is not specific to a fat embolism.
Pain is a common symptom of many conditions and injuries.
Choice B is wrong because pulses 2+ distal to the client’s fracture are normal and indicate adequate blood flow to the extremity.
Choice D is wrong because bruising around the fracture site is an expected finding after a compound fracture and does not indicate a fat embolism.
Normal ranges for blood pressure are 90/60 mmHg to 120/80 mmHg and for heart rate are 60 to 100 beats per minute.
Petechiae are small red or purple spots on the skin caused by bleeding under the skin.
They can range in size from pinpoint to several millimeters. Fat embolism syndrome (FES) is a serious complication of a fat embolism that affects the lungs, skin or brain and can be fatal. FES usually occurs 12 to 72 hours after trauma.
Correct Answer is B
Explanation
Justice is the ethical principle of treating the patient fairly and equally among staff when making assignments. The charge nurse is upholding this principle by ensuring that the workload is distributed evenly and that no staff member is overburdened or underutilized.
Choice A is wrong because Veracity is wrong because veracity is the ethical principle of telling the truth to the patient.
This principle is not relevant to the scenario of making assignments.
Choice C is wrong because Autonomy is wrong because autonomy is the ethical principle of respecting the patient’s right to make their own healthcare decisions.
This principle is not relevant to the scenario of making assignments.
Choice D is wrong because Fidelity is wrong because fidelity is the ethical principle of keeping promises to the patient.
This principle is not relevant to the scenario of making assignments.
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