Walkthrough: Management of Care Q2 – NCLEX-RN®

00:01 Which statement is most appropriate in the assessment phase of the SBAR reporting process? Okay, now, you learned about SBAR in nursing school.

00:10 But remember, we've got situation, background, assessment, and recommendation.

00:16 So look at these four options that we have here.

00:19 Number one, is there anything I should do in the meantime? Number two, I think the client is having a stroke and I'm concerned that they are deteriorating.

00:29 Number three, the client was admitted to the emergency room at 8:20 AM.

00:36 And number four, the last blood pressure was 175/98 and the client has become more confused in the last 15 minutes.

00:47 Okay. Now, I want you to pause the video. You do the work.

00:52 Then we're gonna come back and work through these questions.

00:55 Now, if I was doing this, you've got a scratch paper.

00:58 I would just put one of those four letters by each answer choice to make sure I'm clear what type of answer that is.

01:07 Is it situation? Is it background? Is it assessment or recommendation? What are we looking for? The question says assessment phase.

01:18 So that will help you reassure your brain. You thought through this.

01:21 You know what you're doing.

01:23 And you very clearly will recognize which one is the most appropriate for the assessment phase.

01:29 Okay. Pause the video, do the work, and I'll see you back when you're ready.

01:42 Hey, welcome back. And this one, let's look at number one first.

01:45 So we're looking for the assessment phase.

01:47 A statement that's most appropriate for giving assessment information in our communication with a healthcare provider.

01:55 So number one, is there anything I should do in the meantime? Does that represent the assessment phase? No. This is the recommendation phase.

02:06 This is when you've made recommendations to the healthcare provider, you know, based on the client's assessments.

02:12 So this is not assessment. This is recommendation. Let's look at the next one.

02:19 I think the client is having a stroke. And I'm concerned they are deteriorating.

02:24 Okay. So is that a situation, background, assessment, or recommendation? What did you think? Well, this is really assessment, right? You're looking at what has gone on? This is appropriate for the nurse to say.

02:43 "Hey, this is what I'm seeing. This is what I have assessed.

02:46 And this is what my idea is or my concern." So for now, I'm gonna leave number two in.

02:52 That's clearly something that could be in the assessment phase, but I'm going to look at number three and number four, just to make sure that number two is really the best answer.

03:03 Now, looking at number three, the client was admitted to the emergency room at 8:20 AM.

03:09 Is that situation, background, assessment, or recommendation? That's situation. So it's not assessment.

03:18 That's what we're looking for in this question, but this one is situation.

03:21 This just tells you what has occurred. A client, they're in the emergency room, and it came in at 8:20 AM.

03:29 So we can cross number three off because that does not represent assessment.

03:34 So, so far, we've eliminated number one, number three. We kept number two in.

03:40 Now, we're gonna take a look at our last option, number four, and see if it's the best one for assessment.

03:47 Number four, the last blood pressure was 175/98 and the client has become more confused in the last 15 minutes.

03:58 Now, which one did you label this? This is actually background phase.

04:03 Situation, we told them, "They're in the ER. They came in at 8:20." This statement is giving background information.

04:10 What has happened up to this point, right? So we can rest assured the best answer that reflects assessment is number two.

04:21 Okay, how'd you do? Spend some time reflecting on it, make some notes in your notebook.

04:26 Things that you can take from this question and apply to your next question.

04:32 Keep going, hang in there. I know you can do this.