FPCC – Exam 2 – 2026 – Study Guide and
Practice Material
Documentation - ANS✔✔ act of recording patient status & care in written form or electronic
form , or in a combination of the 2.
Explain the purposes of documentation - ANS✔✔ 1. communication "continuity of care"
2. legally
3. financially
4. education & quality improvement
Explain how, when, & why to complete an incident report. - ANS✔✔ -if an event that happens
that isn't consistent with routine care (a never event- pt developing a pressure ulcer, falling)
-*first assess the pt & the pt's response (vitals, comments, complaints of pain)*
-then inform provider
-provide objective descriptions & subjective comments
-dont include in the chart that you filed an incident report, only write what happened
-if it was a near miss, fill out an incident report to prevent it from happening in the future.
Discuss the key elements of giving an oral patient report - ANS✔✔ face-to-face: ideal & most
common. keep organized by using SBAR
walking rounds- standard that the handoff should be given at the bedside
taped recording
must include significant info: name, age, diagnosis admitted with
changes in the treatment plan that happened
,DO NOT include routine care
What abbreviations can be used in charting? - ANS✔✔ NONE. never accept an order that has an
abbreviation.
Explain the process for verifying or questioning a medical order. - ANS✔✔ -If an order is written
illegibly on a paper order sheet or is entered into the EHR missing components, contact the
provider.
-If you still do not feel comfortable after contacting the provider, you may refuse to carry it out.
-Inform the chain of command of your refusal.
Nursing admission data forms - ANS✔✔ used to establish a baseline to monitor change,
provides information about the clients support system, contains the critical information on why
the client is there.
Flowsheets/graphic records - ANS✔✔ use to document assessments and care that are
performed frequently, on a reoccurring schedule, or as a part of unit routines. (Vital signs)
Integrated plan of care - ANS✔✔ combination of care plan & patient chart.
Summarize the process for receiving & documenting verbal & telephone orders - ANS✔✔ -
Carefully identify client.
-Immediately record the order.
-Always repeat the order back & document that too
-Document that you did that/read the order back.
-Question if needed.
-Document TO for telephone order, VO for verbal order.
,-If uncomfortable/in a high-risk situation, ask them to repeat order to another nurse.
-The order has to be signed by the person who gave it to you within 24 hours, electronically or
on paper chart.
How much fluid should we encourage our patients to drink daily? - ANS✔✔ 2200-2700 mL
How is intake of ice chips measured for a patient's I&O? - ANS✔✔ 1 cup of ice =1/2 a cup of
fluid
What are colloids? - ANS✔✔ larger protein molecules
ex: albumin
Albumin & prealbumin are big factors in predicting ____ - ANS✔✔ skin health
What are examples of crystalloids? - ANS✔✔ small proteins
-sodium, chloride, potassium
Monitoring daily weights - ANS✔✔ -Measure weights first thing in the morning, same time
everyday.
-Use same scale
-Void before weighing
-Client needs to be wearing the same thing each time
-Can delegate this
-Client can do this at home, if they are gaining more than *2.2 pounds a day*, they need to call
the provider & check in about what's going on
-1 pound increase is about 500mLs of fluid retention.
, We lose about how much fluid in our stool per day? - ANS✔✔ 100-200 mL/day
How much fluid do we lose through urine a day? - ANS✔✔ 1500mL/day
What are examples of insensible losses & can they be measured? - ANS✔✔ -lungs, skin
cannot be measured
Intracellular fluid - ANS✔✔ contained within the cells.
accounts for 40% of body weight & is essential for cell function & metabolism
Extracellular fluid - ANS✔✔ outside the cells. carries water, electrolytes, nutrients, and oxygen
to the cells & removes waste.
accounts for 20% of body weight
interstitial fluid - ANS✔✔ lies in the spaces between the body cells
intravascular fluid - ANS✔✔ plasma within the blood. main function is to transport blood cells
transcellular fluid - ANS✔✔ specialized fluids that are contained body spaces (ex: cerebrospinal
fluid)
Third spacing - ANS✔✔ fluid is trapped in a third compartment- not within interstitial or the
intravascular spaces.
Sodium is a major cation in the _____ fluid - ANS✔✔ extracellular
Normal Na+ level - ANS✔✔ 135-145 mEq/L
Practice Material
Documentation - ANS✔✔ act of recording patient status & care in written form or electronic
form , or in a combination of the 2.
Explain the purposes of documentation - ANS✔✔ 1. communication "continuity of care"
2. legally
3. financially
4. education & quality improvement
Explain how, when, & why to complete an incident report. - ANS✔✔ -if an event that happens
that isn't consistent with routine care (a never event- pt developing a pressure ulcer, falling)
-*first assess the pt & the pt's response (vitals, comments, complaints of pain)*
-then inform provider
-provide objective descriptions & subjective comments
-dont include in the chart that you filed an incident report, only write what happened
-if it was a near miss, fill out an incident report to prevent it from happening in the future.
Discuss the key elements of giving an oral patient report - ANS✔✔ face-to-face: ideal & most
common. keep organized by using SBAR
walking rounds- standard that the handoff should be given at the bedside
taped recording
must include significant info: name, age, diagnosis admitted with
changes in the treatment plan that happened
,DO NOT include routine care
What abbreviations can be used in charting? - ANS✔✔ NONE. never accept an order that has an
abbreviation.
Explain the process for verifying or questioning a medical order. - ANS✔✔ -If an order is written
illegibly on a paper order sheet or is entered into the EHR missing components, contact the
provider.
-If you still do not feel comfortable after contacting the provider, you may refuse to carry it out.
-Inform the chain of command of your refusal.
Nursing admission data forms - ANS✔✔ used to establish a baseline to monitor change,
provides information about the clients support system, contains the critical information on why
the client is there.
Flowsheets/graphic records - ANS✔✔ use to document assessments and care that are
performed frequently, on a reoccurring schedule, or as a part of unit routines. (Vital signs)
Integrated plan of care - ANS✔✔ combination of care plan & patient chart.
Summarize the process for receiving & documenting verbal & telephone orders - ANS✔✔ -
Carefully identify client.
-Immediately record the order.
-Always repeat the order back & document that too
-Document that you did that/read the order back.
-Question if needed.
-Document TO for telephone order, VO for verbal order.
,-If uncomfortable/in a high-risk situation, ask them to repeat order to another nurse.
-The order has to be signed by the person who gave it to you within 24 hours, electronically or
on paper chart.
How much fluid should we encourage our patients to drink daily? - ANS✔✔ 2200-2700 mL
How is intake of ice chips measured for a patient's I&O? - ANS✔✔ 1 cup of ice =1/2 a cup of
fluid
What are colloids? - ANS✔✔ larger protein molecules
ex: albumin
Albumin & prealbumin are big factors in predicting ____ - ANS✔✔ skin health
What are examples of crystalloids? - ANS✔✔ small proteins
-sodium, chloride, potassium
Monitoring daily weights - ANS✔✔ -Measure weights first thing in the morning, same time
everyday.
-Use same scale
-Void before weighing
-Client needs to be wearing the same thing each time
-Can delegate this
-Client can do this at home, if they are gaining more than *2.2 pounds a day*, they need to call
the provider & check in about what's going on
-1 pound increase is about 500mLs of fluid retention.
, We lose about how much fluid in our stool per day? - ANS✔✔ 100-200 mL/day
How much fluid do we lose through urine a day? - ANS✔✔ 1500mL/day
What are examples of insensible losses & can they be measured? - ANS✔✔ -lungs, skin
cannot be measured
Intracellular fluid - ANS✔✔ contained within the cells.
accounts for 40% of body weight & is essential for cell function & metabolism
Extracellular fluid - ANS✔✔ outside the cells. carries water, electrolytes, nutrients, and oxygen
to the cells & removes waste.
accounts for 20% of body weight
interstitial fluid - ANS✔✔ lies in the spaces between the body cells
intravascular fluid - ANS✔✔ plasma within the blood. main function is to transport blood cells
transcellular fluid - ANS✔✔ specialized fluids that are contained body spaces (ex: cerebrospinal
fluid)
Third spacing - ANS✔✔ fluid is trapped in a third compartment- not within interstitial or the
intravascular spaces.
Sodium is a major cation in the _____ fluid - ANS✔✔ extracellular
Normal Na+ level - ANS✔✔ 135-145 mEq/L
