# The night-shift nurse receives a telephone order from the on-call provider for "morphine 4 milligrams IV every 2 hours as needed for pain." Which action by the nurse demonstrates correct closed-loop communication?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373130&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: MOC

## Question

The night-shift nurse receives a telephone order from the on-call provider for "morphine 4 milligrams IV every 2 hours as needed for pain." Which action by the nurse demonstrates correct closed-loop communication?

## Option

1. Document "morphine 4 mg IV q2h prn pain" in the EHR and proceed to administer the next dose.
2. Repeat the order back verbatim to the provider for confirmation: "morphine four milligrams IV every two hours as needed for pain — please confirm." Wait for confirmation before entering and administering. **✔ Correct answer**
3. Ask the charge nurse to listen on a second line so two nurses can witness the order.
4. Refuse all telephone orders during night shift and ask the provider to call back during the day.

**Correct answer: 2**

## Explanation

Joint Commission National Patient Safety Goal requires READ-BACK of every verbal/telephone order: write/enter the order, read it back to the provider, and obtain confirmation BEFORE proceeding. Reading numbers digit-by-digit ("four milligrams" not "4 mg") avoids "fourteen" / "forty" mishearing errors. Entering without read-back (1) violates patient safety policy. Two-nurse listening (3) is not standard. Refusing telephone orders (4) is unrealistic and not supported by policy.

## In-depth explanation

The closed-loop communication standard is RECEIVE → WRITE → READ-BACK → CONFIRM. Numbers should be spoken in full ("one zero" instead of "ten") to prevent mistakes. Some hospitals also require entering the order in the EHR for the provider to electronically sign within 24 hours.

## Clinical scenario

Night shift, post-op patient with pain. The on-call provider gives a **telephone order** for morphine. The unit policy and Joint Commission National Patient Safety Goal require **read-back verification** of every verbal/telephone order.

## Key concepts

- **Closed-loop communication** — Receive → write → read-back → confirm before acting on a verbal/telephone order.
- **Joint Commission NPSG** — National Patient Safety Goal requires read-back verification of all verbal/telephone orders.
- **Number-by-number readback** — Speak each digit aloud (for example "four zero" instead of "forty") to prevent mishearing.

## Related questions

- [A patient with severe contamination obsessive-compulsive disorder is starting exposure and…](https://mymerci.kr/pages/nclex_q.php?qn_id=372864&lang=en)
- [A nurse is providing HPV vaccine education to the parent of an 11-year-old at a routine we…](https://mymerci.kr/pages/nclex_q.php?qn_id=372865&lang=en)
- [An 82-year-old patient with moderate Alzheimer dementia becomes increasingly agitated, res…](https://mymerci.kr/pages/nclex_q.php?qn_id=372904&lang=en)
- [An adult patient has been seizing continuously for 6 minutes. The provider asks the nurse …](https://mymerci.kr/pages/nclex_q.php?qn_id=373126&lang=en)
- [Four patients arrive in the ED. Which patient presentation indicates a hypertensive EMERGE…](https://mymerci.kr/pages/nclex_q.php?qn_id=373127&lang=en)
- [A patient has a serum potassium of 2.8 mEq/L and a new order for IV potassium chloride 40 …](https://mymerci.kr/pages/nclex_q.php?qn_id=373128&lang=en)
- [A patient on chronic phenytoin for seizure disorder reports new diplopia and unsteady gait…](https://mymerci.kr/pages/nclex_q.php?qn_id=373129&lang=en)
- [A 72-year-old presents to the ED with sudden right-sided weakness and aphasia. Family stat…](https://mymerci.kr/pages/nclex_q.php?qn_id=373516&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=373130&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=373130&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=373130&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=373130&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=373130&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

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