Identify the correct sequence of ISBAR-R.
Information, Standard, Background, Advice and Recommendation
Introduction, Statistics, Background, Actions and Recommendation
Introduction, Situation, Background, Assessment and Recommendation/ Read back
Information, Situation, Background, Alertness, Response to treatment
The Correct Answer is C
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. North American Nursing Diagnosis Association (NANDA) revises the diagnostic labels every 5 years:
This statement is not accurate. The North American Nursing Diagnosis Association (NANDA) International does review and revise the nursing diagnoses regularly, but it's not on a fixed 5-year schedule. Changes are made based on evolving healthcare practices, new research, and emerging health issues.
B. A nursing diagnosis describes a health problem amenable to intervention:
This statement is true. A nursing diagnosis identifies a specific health problem that can be addressed through nursing interventions. It provides the basis for selecting nursing interventions to achieve outcomes for which the nurse is accountable.
C. Medical diagnosis is included in the nursing diagnosis:
This statement is incorrect. Nursing diagnoses are distinct from medical diagnoses. Medical diagnoses identify diseases or pathologies, whereas nursing diagnoses focus on the patient's responses to the health condition. Nursing diagnoses are within the domain of nursing practice and are formulated based on nursing assessments.
D. LPNs/LVNs formulate nursing diagnoses:
This statement is generally true. Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) can formulate nursing diagnoses as part of their scope of practice. However, the complexity of the diagnosis and the depth of assessment often determine the level of nurse involved in formulating nursing diagnoses. Registered Nurses (RNs) typically handle more complex patient cases and nursing diagnoses
Correct Answer is B
Explanation
A. Developed by an RN:
This option suggests that an RN (Registered Nurse) is solely responsible for creating the initial care plan. While nurses significantly contribute to the care plan, it is often a collaborative effort involving various healthcare professionals, including doctors, nurses, and other specialists.
B. Completed on the day of admission:
This choice means that the initial care plan, outlining the patient's immediate healthcare needs and interventions, is developed and documented on the day the patient is admitted to the healthcare facility. It's essential to establish a plan promptly to ensure the patient receives appropriate and timely care.
C. Used as the basis of care throughout a hospital stay without alteration:
This option suggests that the initial care plan remains unchanged throughout the patient's hospital stay. However, healthcare plans need to be dynamic, adapting to the patient's evolving condition. Care plans are continuously assessed and modified based on the patient's response to treatments and interventions.
D. Developed by the primary care provider and incorporated into the nursing care:
This choice implies that the initial care plan is created by the primary care provider (which could be a doctor) and then integrated into the nursing care. While doctors provide medical diagnoses and orders, nurses play a crucial role in implementing and coordinating the care plan, ensuring the patient's needs are met.
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