A newly licensed nurse is giving a change-of-shift report using Introductions, Situation, Background, Assessment, Recommendation (ISBAR) to an oncoming nurse. Which of the following statements by the newly licensed nurse should be included in the "Background" portion of the report?
"The client has a new prescription for incentive spirometry."
"The client's partner plans to return later today."
"The client has no living family members."
"I initiated a consultation by a nutritionist."
The Correct Answer is C
A. "The client has a new prescription for incentive spirometry.": This statement is more appropriate for the "Assessment" or "Recommendation" section, as it pertains to current treatment plans and interventions rather than the background context of the client's history.
B. "The client's partner plans to return later today.": This information is relevant to the client's social support and engagement but is not critical background information. It may be included in the "Situation" or "Recommendation" sections instead.
C. "The client has no living family members.": This statement is pertinent to the "Background" portion, as it provides important context regarding the client's social situation and support system. Understanding the client's background helps the receiving nurse assess potential psychosocial needs and planning for care.
D. "I initiated a consultation by a nutritionist.": This action relates to ongoing care and assessment of the client's nutritional needs, making it more appropriate for the "Assessment" or "Recommendation" section. It is not part of the historical background needed for effective handoff.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Check the newborn's identification bracelet with the chart: While checking the identification bracelet is important for ensuring the correct identification of the newborn, the request from the grandparent should not be fulfilled without proper identification. It is crucial to prioritize safety and adherence to protocols regarding the newborn's discharge.
B. Obtain permission from the newborn's guardian: Obtaining permission from the newborn's guardian is a necessary step, but the lack of identification from the grandparent still prevents the nurse from allowing the grandparent to take the newborn. The guardian's consent cannot override the identification protocols.
C. Respectfully deny the grandparent's request: Denying the request is the appropriate action in this situation. The nurse must ensure that the newborn is not released to anyone who does not have proper identification, as this is critical for the safety and security of the infant.
D. Review the newborn's footprint record: While reviewing the footprint record can help verify the newborn's identity, it does not address the immediate issue of the grandparent not having an identification bracelet. The nurse's priority should be ensuring that the newborn is only released to authorized individuals with proper identification.
Correct Answer is A
Explanation
A. "We should start tracking how soon clients are discharged after laparoscopic versus open surgery.": This statement reflects the QSEN concept of quality improvement by focusing on collecting and analyzing data related to patient discharge times. By tracking this information, the team can identify trends, evaluate the effectiveness of care, and implement changes to improve patient outcomes and streamline the discharge process.
B. "We should be sure to log out of the computers immediately following documentation.": While this statement emphasizes an important aspect of safety and confidentiality in documentation, it does not directly address quality improvement initiatives. It focuses more on operational procedures rather than evaluating and enhancing the quality of patient care.
C. "We should involve our clients' partners in care planning as much as possible.": Involving clients' partners in care planning aligns with the QSEN concept of patient-centered care. While this approach is essential for improving patient satisfaction and outcomes, it is not specifically a quality improvement initiative.
D. "We should provide change-of-shift report as a team, including the assistive personnel who assisted with care.": This statement reflects teamwork and communication strategies, which are important for effective patient care. However, it does not directly focus on quality improvement initiatives aimed at evaluating and enhancing the overall quality of care provided to clients.
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