A charge nurse is reviewing legal guidelines for documentation with a newly licensed nurse. Which of the following should the charge nurse include in the teaching? (select all that apply)

A medical record can be used as evidence in a court of law

A nurse should ensure the documentation is organized and completed in a timely fashion

Documentation should include the nurse's interpretation of the client situation

Data contained in a client's medical record can be shared with all employees within a health care facility

Information recorded in the client's medical record must be accurate and complete.

Answer and Explanation

Correct Answer : A,B,E

A. A medical record can indeed be used as evidence in a court of law to support or refute claims related to patient care.
B. Documentation should be organized and timely to ensure accuracy and continuity of care.
C. Documentation should not include the nurse's interpretation but rather objective data and actions taken.
D. Data in a client's medical record should only be shared with those directly involved in the client's care unless otherwise authorized.
E. Information recorded in the client's medical record must be accurate and complete to support safe and effective client care and legal purposes.

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Correct Answer is D

Explanation

A. Euphoria, drowsiness, and dizziness are not common side effects of fluticasone.
B. Nasal congestion may occur with fluticasone use, but bleeding gums and black tarry stools are not typical side effects.
C. Fever, weight gain, and tachycardia are not commonly associated with fluticasone use.
D. Sore throat, headache, burning in the nose, and nosebleeds are potential side effects of intranasal fluticasone and should be monitored and reported if they occur.

A. Instill the ophthalmic medication directly on the client's cornea. B. Apply gentle pressure to the client's nasolacrimal duct after instillation. C. Clean the client's eye from the outer canthus to the inner canthus before instillation. D. Ask the client to tightly squeeze their eyes shut after the instillation.

Correct Answer is B

Explanation

Instilling the ophthalmic medication directly on the client's cornea is incorrect and could cause discomfort or injury.
B. Applying gentle pressure to the client's nasolacrimal duct after instillation helps to reduce systemic absorption of the medication and minimize side effects.
C. Cleaning the client's eye from the outer canthus to the inner canthus is unnecessary and not a recommended procedure before instillation.
D. Asking the client to tightly squeeze their eyes shut after instillation may not affect the absorption of the medication and is not necessary.

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A charge nurse is reviewing legal guidelines for documentation with a newly licensed nurse. Which of the following should the charge nurse include in the teaching? (select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is prescribed fluticasone, what complications or side effects should the nurse alert the client to?

Correct Answer is D

Explanation

A nurse is preparing to administer Timolol ophthalmic medication to a client. Which of the following actions should the nurse plan take?

Correct Answer is B

Explanation

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