A nurse is providing a handoff report using the introduction, situation, background, assessment, recommendation, and readback (ISBARR) on a client. Which of the following information should be included in the situation component?
Provider notified of client’s back pain
Request prescription for opioid medication for pain relief
Client is grimacing due to pain
Client admitted with ruptured disc at L5
The Correct Answer is C
Choice A reason: This statement belongs to the recommendation component, as it describes an action that the nurse has taken or suggests to take regarding the client's care.
Choice B reason: This statement also belongs to the recommendation component, as it expresses a need or a request for the client's treatment.
Choice C reason: This statement belongs to the situation component, as it summarizes the current problem or issue that the client is facing.
Choice D reason: This statement belongs to the background component, as it provides relevant information about the client's medical history or diagnosis.
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Related Questions
Correct Answer is D
Explanation
Choice A reason: This statement is incorrect because administering an antiemetic to a client who has post chemotherapy nausea is not medically futile. It is a supportive measure that can help the client to manage the side effects of chemotherapy and improve their comfort and quality of life.
Choice B reason: This statement is incorrect because administering a narcotic analgesic to a client who has end stage cancer is not medically futile. It is a palliative measure that can help the client to relieve their pain and suffering and improve their comfort and quality of life.
Choice C reason: This statement is incorrect because administering oral care for a client who has post chemotherapy mucositis is not medically futile. It is a preventive measure that can help the client to avoid infections and complications and improve their oral health and hygiene.
Choice D reason: This statement is correct because administering chemotherapy to a client who has metastatic cancer is medically futile. It is a curative measure that has no reasonable chance of achieving its intended goal of eradicating the cancer or prolonging the client's survival. It may also cause harm or distress to the client by exposing them to unnecessary risks and side effects.
Correct Answer is D
Explanation
Choice A reason: This statement does not indicate an understanding of acute care, but rather a misconception and a lack of responsibility. Acute care is a level of health care that provides immediate and short-term treatment for severe or life-threatening conditions, such as asthma attacks. Acute care requires the parents to stay with their child and participate in their care plan.
Choice B reason: This statement does not indicate an understanding of acute care, but rather a denial and a delay of treatment. Acute care is not provided at home, but at a specialized facility that has the equipment and staff to handle emergencies. Waiting for the nurse to come may worsen the child's condition and increase the risk of complications.
Choice C reason: This statement does not indicate an understanding of acute care, but rather an exaggeration and a misunderstanding of the duration of treatment. Acute care is not meant to last for a long time, but only until the condition is stabilized or resolved. The length of stay at an acute care facility depends on the severity of the condition and the response to treatment, but it is usually less than a month.
Choice D reason: This statement indicates an understanding of acute care, as it reflects the main goal and intervention of acute care for asthma. Acute care for asthma involves administering medications that can quickly relieve the symptoms and prevent further inflammation of the airways. Medications may include bronchodilators, corticosteroids, oxygen, and others.
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