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The nurse plans to use the Situation, Background, Assessment, and Recommendation (SBAR) format of communication during which interaction?

A.

Reporting a change in a client’s condition to the healthcare provider.

B.

Completing discharge teaching to a client and family members.

C.

Obtaining clarification from a client’s healthcare power-of-attorney.

D.

Offering therapeutic support and comfort to a grieving family.

Answer and Explanation

The Correct Answer is A

Choice A rationale

 

The SBAR (Situation, Background, Assessment, Recommendation) format is specifically designed for critical communication, particularly when reporting a change in a client’s condition to the healthcare provider. This structured communication tool ensures that essential information is conveyed clearly and concisely, reducing the risk of miscommunication and enhancing patient safety.

 

Choice B rationale

 

Completing discharge teaching to a client and family members typically involves providing comprehensive instructions and education, which may not fit the concise and focused nature of the SBAR format. Discharge teaching requires a more detailed and interactive approach to ensure understanding and compliance.

 

Choice C rationale

 

Obtaining clarification from a client’s healthcare power-of-attorney involves a more conversational and detailed exchange of information, which may not align with the structured and concise nature of the SBAR format. This interaction often requires a thorough discussion to ensure all aspects are understood.

 

Choice D rationale

 

Offering therapeutic support and comfort to a grieving family is a sensitive and empathetic interaction that requires a compassionate and patient-centered approach. The SBAR format is not suitable for this type of communication, as it is designed for conveying critical information quickly and efficiently.
 


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Correct Answer is A

Explanation

Choice A rationale

Positive external places are often used in guided imagery to help clients focus on pleasant and calming environments. This technique can help distract from pain and promote relaxation by engaging the mind in a soothing and peaceful visualization.

Choice B rationale

Tranquil sounds can also be beneficial in relaxation techniques, but they are not the primary focus in guided imagery for chronic pain. Guided imagery typically involves visualizing a serene place rather than focusing solely on sounds.

Choice C rationale

Emotional reflection may not be as effective in reducing chronic pain through guided imagery. This technique is more about visualizing positive and calming environments rather than reflecting on emotions.

Choice D rationale

Motivational phrases are useful in other therapeutic techniques but are not the primary focus in guided imagery for chronic pain. Guided imagery focuses more on visualizing serene and peaceful places.

Correct Answer is B

Explanation

Choice A rationale

Assessing the strength of deep tendon reflexes is important in evaluating neuromuscular function, but it is not the most critical intervention for a client with hyperkalemia. Hyperkalemia primarily affects cardiac function, so monitoring the heart is crucial.

Choice B rationale

Determining the apical pulse rate and rhythm is the most important intervention for a client with a serum potassium level of 7.5 mEq/L. Hyperkalemia can cause life-threatening cardiac arrhythmias, and monitoring the heart rate and rhythm can help detect early signs of these complications.

Choice C rationale

Observing the color and amount of urine can provide information about kidney function and hydration status, but it is not the most critical intervention for hyperkalemia. The primary concern with hyperkalemia is its effect on the heart.

Choice D rationale

Comparing muscle strength bilaterally can help assess neuromuscular function, but it is not the most critical intervention for hyperkalemia. The focus should be on monitoring cardiac function to prevent life-threatening complications.

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