NCLEX · Management of Care

A nurse receives a verbal order from a physician by telephone. What is the correct procedure?

Correct answer

Repeat the order back to the physician completely (read-back), document it as a verbal order with the prescriber's name, date, time, and nurse's signature, then ensure the physician countersigns within the facility's required timeframe

  1. A Write the order and implement it without reading it back
  2. B Repeat the order back to the physician completely (read-back), document it as a verbal order with the prescriber's name, date, time, and nurse's signature, then ensure the physician countersigns within the facility's required timeframe
  3. C Refuse to accept verbal orders under any circumstances
  4. D Only accept verbal orders from attending physicians, never residents

Why this is the answer

VERBAL AND TELEPHONE ORDER SAFETY is a Joint Commission National Patient Safety Goal specifically because miscommunication of verbal orders is a leading cause of medication errors. THE REQUIRED PROCESS: (1) RECEIVE the order; write it down simultaneously; (2) READ BACK the complete order word-for-word to the prescriber; (3) RECEIVE CONFIRMATION that the read-back is correct ('that is correct'); (4) DOCUMENT: Record in the chart as a verbal order with the prescriber's name, date, time, the full order, and the receiving nurse's name/credentials; some facilities use 'V.O. Dr. Smith / T.O. (telephone order)' notation; (5) COUNTERSIGNATURE: The prescriber must sign (countersign) the order within the facility's policy timeframe — typically 24 hours for routine orders, immediately for emergencies in some facilities. WHY READ-BACK MATTERS: Common verbal communication errors include: sound-alike drug names (Celebrex/Celexa, Toradol/Tramadol); numbers (15 mg vs 50 mg sounds similar by phone); wrong patient (same-sounding names). The read-back gives the prescriber a chance to catch these errors before they reach the patient. WHEN VERBAL ORDERS ARE APPROPRIATE: Emergencies; situations where the prescriber cannot physically be present; after-hours phone calls. WHEN TO CLARIFY: If the order seems unusual, too high/low a dose, or potentially dangerous — the nurse has both a right and obligation to clarify before implementing.
Source: NCLEX-RN Test Plan: Safe Care — Verbal/Telephone Orders

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