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1. A charge nurse is reviewing documentation with a group of newly licensed
nurses. Which of the following legal guidelines should be followed when
documenting in a clients record? (Select all that apply)
A. Cover errors with correction fluid, and write in the correct
information
B. Put the date and time on all entries
C. Document objective data, leaving out opinions
D. Use as many abbreviations as possible
E. Wait until the end of the shift to document - Correct Answer: B, C
B. Put the date and time on all entries
C. Document objective data, leaving out opinions
2. A nurse is receiving a providers prescription by telephone for morphine for
a client who is reporting moderate to sever pain. Which of the following
nurse actions are appropriate? (Select all that apply)
A. Repeat the details of the prescription back to the provider
B. Have another nurse listen to the telephone prescription
C. Obtain the patients signature on the prescription within 24 hours
D. Decline the verbal prescription because it it is not an emergency
situation
E. Tell the charge nurse that the provider has prescribed morphine by
telephone - Correct Answer: A, B, C
Repeat the details of the prescription back to the provider
Have another nurse listen to the telephone prescription
, Obtain the patients signature on the prescription within 24 hours
3. A nurse is discussing occurrences that require completion of an incident
report with a newly licensed nurse. Which of the following should the nurse
include in the teaching? (Select all that apply)
A. Medication Error
B. Needlesticks
C. Conflict with a provider and nursing staff
D. Omission of prescription
E. Missed specimen collection of a prescribed laboratory test -
Correct Answer: A, B, D
Medication Error
Needlesticks
Omission of prescription
4. A nurse manager is discussing the HIPPA Privacy Rule with a group of newly
hired nurses during orientation. Which of the following information should
the nurse manager include? (Select all that apply)
A. A single electronic records password is provided for nurses on the
same unit
B. Family members should provide a code prior to receiving client
health info
C. Communication of client information can occur at the nurses station
D. A client can request a copy of their medical record
E. A nurse can photocopy a clients medical record to transfer to another
facility - Correct Answer: B,C,D,E
, B. Family members should provide a code prior to receiving client health
info
Communication of client information can occur at the nurses station
A client can request a copy of their medical record
A nurse can photocopy a clients medical record to transfer to another
facility
5. SOAP - Correct Answer: Subjective, objective, assessment, plan
6. PIE - Correct Answer: problem, intervention, evaluation
7. DAR (focus charting) - Correct Answer: data, action, response
8. ABCDE Principle in Emergency Situations - Correct Answer:
Airway/cervical spine
Breathing
Circulation
Disability
Exposure
9. A nurse is providing info about how to reduce the risk of poisoning to a
group of infants and toddlers to a group of guardians. What information
should nurse include? - Correct Answer: Keeping house plants and
cleaning products out of reach, look for paint chips as those at this age tend
to consume these, poison control hotline readily available, place poisonous
, products in locked cabinet, keep medications in child proof containers and
locked up, disposed of unused medications
10.A nurse is providing education on infant safety to a group of guardians.
Which of the following statements by a guardian indicates an understanding
of the teaching?
A. I should line the crib with bumper pads
B. I will make sure the crib slats are no more than 3 inches apart
C. I should place the baby on their back when sleeping
D. I should place the baby in a vehicle safety seat facing forward in the back seat
of a car - Correct Answer: C. I should place the baby on their back when
sleeping
11. A nurse is educating a new home health aide about home safety for the
older adult. What information should nurse include? - Correct Answer:
Loose/scatter rugs should be removed, electrical and extension cords
behind furniture and against wall, steps and sidewalks in good repair, grab
bars installed in bathroom, nonskid mat in tub/shower, stool rise use,
shower sear and bedside commode may be necessary, adequate lighting,
removal of clutter
12. A nurse is performing a primary survey for a client who has a life threating
condition. In which order should the nurse perform the assessment?
A. Check the clients LOC
B. Check the clients airway
C. Check the clients exposure to adverse elements
D. Check the clients ventilation