When the unconscious patient is admitted and is unable to provide data during assessment, information provided by the family is classified as:

A. Tell the charge nurse that the provider has prescribed morphine by telephone
While notifying colleagues may be appropriate, this is not required as part of accepting a verbal/telephone order.

B. Record the reason for the call made to the provider and the results of the call in the Nurses' Notes
Documentation should include why the call was made, what was discussed, and what actions were taken, to maintain legal and clinical accuracy.

C. Refuse to accept the verbal prescription because this is not an emergency
While verbal orders should be limited to urgent situations, nurses may accept telephone prescriptions following proper verification and documentation protocols.

D. Repeat the details of the prescription back to the provider
This is a required safety step-called a "read-back"-to ensure accuracy of telephone orders.

A. disoriented patient
Disorientation indicates a potential neurological or metabolic problem and warrants a focused assessment.

B. non-responsive patient
A non-responsive status is critical and requires a focused (and often rapid) assessment to determine the cause and intervene.

C. critically ill patient
Critically ill patients often require frequent focused assessments based on the system affected (e.g., respiratory, cardiovascular).

D. patient’s vital signs are B/P 120/80, P 88 and R 18
These are normal vital signs, and if the patient is stable, a focused assessment is not immediately necessary unless other concerns are present.