Chapter 29 Flashcards
What is an advantage for using SBAR during staff communication?
Improves verbal communication and reduces medical errors
The nurse is calling the health care provider about a patient’s changing condition. Which of the following would be included in the SBAR communication?
Situation, background, assessment, and recommendation
The nursing assistant takes the vital signs for the 12 patients on the unit. Who is responsible for interpreting the results?
The registered nurse assigned to the patient(s) should interpret the vital signs.
The nurse administers an intravenous dose of pain medication. The nurse should reassess the patient in:
15 minutes
Which of the following patients should the nurse assess first?
A 48-year-old patient with shortness of breath and pulse oximeter reading of 88%
Which priority action should the nurse take when performing an initial assessment of pain status of a patient who is receiving pain control via patient-controlled analgesia (PCA)?
Ask the patient to rate his or her pain on a numeric scale of 1 to 10.
A nurse is reviewing a patient’s vital signs that have been taken by a nursing assistant and noted in the patient’s medical record. The blood pressure measurement noted is 60/40. What should the nurse do based on reviewing this information in the patient’s chart?
Go directly to the patient and retake the blood pressure.
A nurse is evaluating the neurologic system of a patient. Which assessment would be included in the neurologic examination?
Observe the patient for ptosis.
A patient has a urinary catheter. Which assessment should be done each time vital signs are taken on the patient?
Observing the color of the output
Which finding would require immediate action by the nurse if found during the physical assessment?
Oxygen saturation of 88%
