# A nurse coming on duty for the night shift reviews the EHR tabs for a 65-year-old client admitted with COPD exacerbation. Before accepting handoff, which information should the oncoming nurse ask the off-going nurse to clarify?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372269&lang=en  
> language: en  
> subject: Concepts of Management  
> category: MOC

## Question

A nurse coming on duty for the night shift reviews the EHR tabs for a 65-year-old client admitted with COPD exacerbation. Before accepting handoff, which information should the oncoming nurse ask the off-going nurse to clarify?

History

Vitals

Labs

Orders

Notes

65-year-old male, admitted yesterday for COPD exacerbation. Long-standing severe COPD, 40 pack-year smoking history (quit 5 years ago), former coal miner. DNR/DNI status confirmed on admission. Family present and supportive.

BP 138/82, HR 92, RR 22, T 37.1 C, SpO2 91 percent on 2 L nasal cannula. Time of measurement not documented in the handoff note.

WBC 14.2 (high), Hgb 13.4, BMP within normal limits, ABG pH 7.35, PaCO2 52, PaO2 64, HCO3 28. Time of ABG draw not documented in the handoff note.

Prednisone 40 mg PO daily; azithromycin 500 mg PO daily; ipratropium-albuterol nebulizer every 4 hours; oxygen 2 L NC titrated to SpO2 88-92 percent; full diet; out of bed as tolerated; pulmonary rehab consult.

Off-going RN handoff note: "Client is DNR/DNI, family at bedside, on standard COPD bundle. Will continue current orders. Please call respiratory therapy if breathing changes."

1

The clients home medication list and dietary preferences for breakfast

✕

2

The most recent vital signs with timestamp, the timing of the last arterial blood gas, and the latest oxygen saturation on the current liter flow

✕

3

The visiting hours posted in the lobby and the location of the nearest restroom for family

✕

4

The detailed billing code for the COPD admission and the insurance deductible balance

✕

## Explanation

Why option 2
SBAR-based handoff requires current Situation, Assessment, and Recent data. Without timestamps for vitals and ABG, the oncoming nurse cannot tell whether the SpO2 91 percent on 2 L is improving, plateauing, or worsening. Clarifying the timing of the last vitals and ABG is essential before accepting responsibility.

Why not the others
Home medication list and breakfast preferences are not the priority at handoff (medications are reconciled separately; meals are scheduled by dietary). Visiting hours and restroom location are not clinical handoff content. Billing details are administrative and unrelated to clinical safety.

## In-depth explanation

Step 1 — Anchor the framework
The Joint Commission requires structured handoff with content covering Situation, Background, Assessment, Recommendation (SBAR) plus opportunity for questions. Recency and timestamps are part of "Assessment".

Step 2 — Identify the gaps
The handoff note records DNR/DNI status and family availability (good) but omits timing of the most recent vitals and the timing of the last ABG result. SpO2 91 percent on 2 L could be a 4-hour-old number or a fresh reading; the clinical implication is very different.

Step 3 — Ask before accepting
The oncoming nurse should pause acceptance and request clarification for option 2 items. Accepting handoff without that data leaves the nurse responsible for an unverifiable patient state.

Key concept
NCLEX rewards reading a handoff note for what is missing, not just what is written. Timestamps and recency are core safety information.

## Clinical scenario

Scenario
Night-shift nurse, arriving for handoff on a 65-year-old male admitted yesterday for COPD exacerbation.

Background
The off-going nurse provides a brief written handoff and the EHR tabs are open. The oncoming nurse reads History, Vital Signs, Labs, Orders, and Notes, then prepares to ask any clarifying questions before accepting responsibility.

Background framework
The Joint Commission requires structured handoffs (often using SBAR). Common gaps include missing timestamps for the most recent assessment and unclear timing of recent labs.

## Key concepts

- **SBAR** — A structured communication framework: Situation, Background, Assessment, Recommendation. Used at handoff and physician contact to standardize content and reduce omissions.
- **Joint Commission handoff requirement** — A national patient safety goal requiring that handoff include up-to-date information on condition, medications, treatments, recent and anticipated changes, and an opportunity for questions and clarification.
- **Read-back / verbal confirmation** — A safety practice during verbal communication where the receiver repeats critical information back to the sender, especially for medications, allergies, code status, and verbal orders.

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