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24問 • 2年前

問題一覧

which intervention should the nurse implement to facilitate continuity of care ?

ensure documentation of the client’s appearance, behavior ,and responses

a nurse is caring for a client who is having an extended recovery period. which intervention wound be most effective in improving care for this client?

review the clients health record

which the primary goal for maintaining a healthcare record for the client and particular

Vital signs

Which nursing interventions are helpful when considering the facility's need to be financially accountable? Select all that apply.

Document all the treatment given to each client, Record all billable services and the appropriate health record, verify the use of specific equipment required to provide safe client care

A nurse is caring for a client in a healthcare facility who is about to be transferred to another healthcare facility for specialized care. Which data would be most helpful to ensure continuity of care?

Transfer notes summarizing care

Which document would be most helpful in Determining the clients ability to perform activities of daily living

residencet protocol(RAP)

which statement describes the purpose of progress records

Describes the treatment and response of the client

Which type of note does the nurse enter into the medical record at regular intervals to summarize the client's condition or response to treatment?

Progress

Which data entry system are examples of focus charting? Select all that apply.

APIE, PIE, DARE

Which statement describes the best technique for identifying that a written ever was made in a manual record sheet

Cross out the incorrect statement with a single line

During a change of shift reporting, a nurse has to substitute for the nurse who was primarily responsible for the care of a client. Which process would be most effective for the nurse's change-of-shift reporting?

prepare a written summary for the ongoing nurse

The nurse has to document information to maintain the health record of the client. Which nursing action is required for each charting entry?

which statement accurately describes Aspects of computerized charting

The system provides speed and convenient for both entering and retrieving information

A nurse makes an entry in a client's chart that includes documentation about the client's routine care, the nurse's observations, the clients problems. The nurse arranges the documentation in a chronological order, from the time the nurse started the shift until the nurse documented in the client's record. Which type of documentation best describes what the nurse did in the client's chart?

narrative

The nurse is reviewing a chart updated using the charting by exception format. Where would the nurse find the client's most recent lung sounds?

Flow sheets

When considering documentation, what information should the nurse include on the client's MAR?

Lists all the medications that the primary care provider has ordered for the client with spaces for the caregiver to mark when medications are given.

What key guidelines are generally accepted for documentation of nursing care? Select all that apply.

Documentation should be specific., Use direct quotes in documentation whenever possible., Documentation should be completed promptly., Document what you see.

Which statement entered into the medical record by the nurse is both objective and descriptive while demonstrating the principles of documentation?

Client rocking in chair

Which is the correct abbreviation for teaspoon?

tsp

Which is the correct abbreviation for before meals?

What is the meaning of the abbreviation BID?

Twice a day

Why were apothecary units placed on the "do not use" list? Select all that apply.

Misinterpreted because of similar abbreviations for multiple medications, Unfamiliar to many practitioners, Easily confused with metric units, Commonly mistaken for the number two

Why was U placed on the "do not use" list? Select all that apply.

Mistaken for zero, Mistaken for the number 4, Mistaken for cubic centimeters

What is the meaning of the abbreviation "Ungt"?

Ointment