A nurse is giving a handoff report for a client whose blood … | 마이메르시 MyMerci
Client Rights MOC
Question

A nurse is giving a handoff report for a client whose blood pressure is falling and urine output has decreased. Which information should be included in the recommendation portion of SBAR?

Explanation

The recommendation portion of SBAR states what action or response is needed. Falling blood pressure and low urine output suggest poor perfusion, so urgent evaluation is appropriate. Background and assessment data are important but belong in other SBAR sections.

In-depth explanation

<span class='merci-scenario-label'>Clinical Judgment</span><br>Use the client cues, timing, labs, and safety risks to select the response that best fits SBAR recommendation for deterioration.<br><br><span class='merci-scenario-label'>Memory Tip</span><br>Match the strongest cue cluster to the safest nursing judgment.<br><br><span class='merci-scenario-label'>KR vs US</span><br>NCLEX items reward cue-based priority thinking rather than isolated recall.

Clinical scenario

<span class='merci-scenario-label'>Clinical Practice Guide</span><br>For SBAR recommendation for deterioration, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.<br><br><span class='merci-scenario-label'>Caution</span><br>Do not choose an action from one isolated cue when the full scenario changes priority or safety.

Key concepts

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For study reference only. Always follow current clinical guidelines and your institution’s protocols.