When a night shift nurse completes a shift, she gives a report ...

[leo leo]

When a night shift nurse completes a shift, she gives a report about her clients to the oncoming day shift nurse.
 
  When beginning the report, the night shift nurse introduces herself and states her role, states the client's name, identifiers, age, sex, and location. Which of the following should the nurse do next?
 
  a. State critical lab reports, allergies, and alerts
  b. List current medications and client's family history
  c. Talk about any anticipated changes in the plan of care
  d. Relate client's chief complaint, vital signs, symptoms, and diagnosis

Question 2

When communicating with a client's physician, the nurse suggests ordering a STAT chest x-ray for a client who is experiencing dyspnea. This is an example of which component of the SBAR format for communicating with the client's physician?
 
  a. Situation
  b. Assessment
  c. Background
  d. Recommendation

[mjenn52]

Answer to Question 1

ANS: D
When using the acronym I PASS the BATON, the nurse should first introduce herself and state her role; then state the client's name, identifiers, age, sex, and location; and then go over the client's assessment, including the chief complaint, vital signs, symptoms, and diagnosis.
The fifth step in I PASS the BATON is safety concerns, which include critical lab reports, allergies, and alerts. The sixth step in I PASS the BATON is background, which includes comorbidities, previous episodes, current medications, and family history. The final step in I PASS the BATON is next, in which the plan is stated, including what will happen next, and includes any anticipated changes.

Answer to Question 2

ANS: D
During the recommendation component of SBAR, the nurse states an informed suggestion for the continued care of the client by proposing an action and stating what is needed and in what time frame it needs to be completed. During the situation component of SBAR, the nurse identifies herself, the client, and the problem. During the assessment component of SBAR, the nurse states a conclusion that is based on what she thinks is wrong. During the background component of SBAR, the nurse relates the client's background.