A nurse is reviewing a transcribed phone call regarding a recently admitted client. The client was admitted for a urinary tract infection. What component of ISBAR is missing from this communication?
No missing component
Situation
Background
Assessment
Recommendation
The Correct Answer is C
Choice A reason: Indicating that no component is missing is incorrect because the communication did not provide sufficient background information, such as the client’s history or relevant details leading to the current situation.
Choice B reason: The situation was adequately described, including that the client was admitted with a urinary tract infection, so this component is present.
Choice C reason: Background information, including relevant past medical history, baseline assessments, or context for the current situation, was not included. Providing background is essential for clear communication and safe handoff.
Choice D reason: The assessment component would include the nurse’s observations, vital signs, and physical findings. While this may have been partially present, the primary missing element was background, not assessment.
Choice E reason: Recommendation involves suggested actions or next steps. While important, the lack of background information makes it difficult for the receiving party to understand or act appropriately, highlighting why background is the missing component.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Outdoor play supports physical health and wellness by promoting gross motor development, cardiovascular fitness, and exposure to fresh air and sunlight, which aids in vitamin D synthesis. It also encourages social interaction, creativity, and stress reduction. Preschool-aged children benefit most from active play that enhances both physical and emotional well-being.
Choice B reason: Building with clay supports fine motor skills and creativity but does not provide the same level of physical activity needed for overall health and wellness. While beneficial for cognitive and artistic development, it does not address the physical activity requirements of preschoolers.
Choice C reason: Story time enhances language development, listening skills, and imagination. However, it is a sedentary activity and does not directly support physical health and wellness, which is a priority at this developmental stage.
Choice D reason: Painting fosters creativity and fine motor skills but is also sedentary. While important for cognitive and emotional growth, it does not provide the physical activity necessary for health and wellness in preschool-aged children.
Correct Answer is A
Explanation
Choice A reason: Telling a client they are making a big mistake is judgmental and nontherapeutic. It undermines autonomy and may increase resistance. Therapeutic communication requires respect and support, even when clients make difficult decisions.
Choice B reason: Offering information before the client leaves is therapeutic. It ensures the client is making an informed decision and demonstrates concern for their well-being.
Choice C reason: Exploring the client’s reasons for leaving is therapeutic. It allows the nurse to address concerns, clarify misunderstandings, and potentially resolve issues that led to the decision.
Choice D reason: Respecting the client’s decision while informing them of risks balances autonomy with professional responsibility. It is therapeutic and ensures the client understands the consequences of leaving AMA.
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