Nokea
JCAHO regulates standards of care to:
- A. ensure subjective documentation
- B. make sure that all nurses use the same charting system
- C. ensure quality patient care
- D. make sure insurance companies get paid correctly
Correct Answer: C
Rationale: JCAHO (C) focuses on improving patient safety and care quality through standards. A is incorrect as objective documentation is emphasized. B is incorrect as charting systems vary. D is incorrect as reimbursement is not JCAHO's focus.
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Which of the following statements is correct about abbreviations?
- A. Every facility should have an approved abbreviations list.
- B. Creating abbreviations saves time for the person reading the chart.
- C. Writing out questionable abbreviations could make a jury think you're hiding something
- D. Abbreviating drug name and dosages helps reduce medication errors.
Correct Answer: A
Rationale: Approved abbreviation lists (A) ensure clarity and prevent errors. B, C, and D are incorrect as unapproved abbreviations cause confusion and risks.
Patient with a nursing diagnosis of airway clearance, ineffective
The patient with a nursing diagnosis of airway clearance, ineffective, might have a desired patient outcome of:
- A. oxygen will be continued
- B. the patient's coughing frequency will increase
- C. cyanosis may be present
- D. within 24 hours, the patient will demonstrate no signs or symptoms of dyspnea
Correct Answer: D
Rationale: The desired outcome for ineffective airway clearance (D) is measurable improvement, like no dyspnea within 24 hours. A is an intervention, B does not ensure clearance, and C indicates worsening.
How is Maslow's Hierarchy of Human Needs used by nurses in a clinical setting?
- A. It serves as a reminder of human growth and development across the life span
- B. It helps in prioritizing nursing diagnoses and care
- C. It outlines the basic psychological needs that people have when they are hospitalized and feel anxiety
- D. It is a framework for thinking critically
Correct Answer: B
Rationale: Maslow's hierarchy (B) prioritizes care by addressing physiological needs first, then safety, love, esteem, and self-actualization. A, C, and D are less accurate uses.
A charge nurse is reviewing documentation with a group of newly hired nurses. Which of the following guidelines should be followed when documenting in a patient record? (select all that apply)
- A. Wait until the end of the shift to document
- B. Cover errors with correction fluid, and write in the correct information
- C. Use as many abbreviations as possible to save space
- D. Document objective data, leaving out opinions
- E. The date and time should be included with each entry
Correct Answer: D,E
Rationale: D: Documentation must be objective (e.g., 'grimaced when moving') to avoid bias. E: Including date and time ensures a clear timeline for legal and care continuity. A is incorrect because timely documentation prevents errors. B is incorrect as errors should be corrected with a single line and initials. C is incorrect because only approved abbreviations should be used to avoid confusion.
On what form/forms should the nurse chart when administering a narcotic?
- A. Physician's Order Sheet
- B. Narcotic Administration Sheet
- C. Care Plan
- D. MAR and Narcotic Administration Sheet
Correct Answer: D
Rationale: Narcotics are documented on both the MAR (Medication Administration Record) (D) for all medications and the Narcotic Administration Sheet for controlled substances to ensure tracking and compliance. A, B alone, and C are incorrect.