A nurse is providing client report using the Situation, Background, Assessment, Recommendation (SBAR) format. Using SBAR, in which order should the nurse provide the information in the report? (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)
The client's temperature is 39.5° C (103.1° F).
Contact the client's provider for a prescription for a sputum culture.
The client reports increasing shortness of breath.
The client has COPD.
The Correct Answer is D,C,A,B
Rationale
- Situation: The client has COPD and is experiencing an acute exacerbation.
- Background: The client has a history of COPD and has been experiencing increasing shortness of breath.
- Assessment: The client's temperature is 39.5°C (103.1°F) and is experiencing shortness of breath.
- Recommendation: Contact the client's provider for a prescription for a sputum culture.
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Related Questions
Correct Answer is A
Explanation
A. Respecting the daughter's decision to refuse the transfusion aligns with the principles of patient autonomy and the authority granted through the durable power of attorney for health care, meaning the daughter's wishes must be followed.
B. Encouraging the daughter to allow the transfusion would undermine her role as the decision-maker and may cause unnecessary conflict, making this option inappropriate.
C. Discussing guardianship is not necessary or appropriate in this context, as the daughter has already been designated as the decision-maker, which negates the need for additional legal intervention.
D. Asking the provider to give consent for the transfusion contradicts the authority granted to the daughter, as she is the legally recognized decision-maker and has already made her choice.
Correct Answer is D,C,A,B
Explanation
Rationale
- Situation: The client has COPD and is experiencing an acute exacerbation.
- Background: The client has a history of COPD and has been experiencing increasing shortness of breath.
- Assessment: The client's temperature is 39.5°C (103.1°F) and is experiencing shortness of breath.
- Recommendation: Contact the client's provider for a prescription for a sputum culture.
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