A nurse is documenting client care in the nurses' notes and notices that a space was left blank.
Which of the following actions should the nurse take?

Black out the line with a felt-tip pen.

Leave the space as it is within the entry.

Draw a horizontal line through the space and sign at the end of the line.

Place the date at the beginning of the space, followed by double lines.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Blacking out the line with a felt-tip pen is not an appropriate action for correcting a blank space in the nurses' notes. It can make the entry look unprofessional and may not be accepted as a proper correction.

Choice B rationale:

Leaving the space as it is within the entry is not the correct action because it does not address the blank space or provide necessary documentation. Blank spaces in documentation should be corrected appropriately.

Choice C rationale:

Drawing a horizontal line through the space and signing at the end of the line is the correct action. This is a standard practice for correcting blank spaces in documentation. It signifies that the space was intentionally left blank and has been reviewed and approved by the nurse.

Choice D rationale:

Placing the date at the beginning of the space, followed by double lines, is not a standard or recommended method for correcting blank spaces in documentation. It can lead to confusion and may not meet documentation standards.

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Correct Answer is C

Explanation

Choice A rationale:

Avoiding the use of draw sheets for repositioning is not a direct intervention for managing urinary incontinence. Draw sheets are typically used for repositioning and preventing pressure injuries. Managing urinary incontinence involves strategies such as toileting schedules, absorbent products, and perineal care.

Choice B rationale:

Limiting periods of sitting in a chair to 4 hours is a general guideline for preventing pressure ulcers in individuals with limited mobility, but it is not specific to managing urinary incontinence. Clients with urinary incontinence may need to sit in chairs for extended periods, and it is essential to address incontinence management separately.

Choice C rationale:

Using a no-rinse perineal cleanser after incontinence is an appropriate intervention for maintaining skin hygiene and preventing irritation in individuals with urinary incontinence. No-rinse cleansers are designed to clean the perineal area without the need for rinsing, making them convenient for incontinence care. Choice D

A. Wash hands with soap and water for 20 seconds. B. Wear sterile gloves when in contact with body fluids. C. Use alcohol-based cleanser when hands are visibly soiled. D. Artificial nails can be worn when performing direct client care.

Correct Answer is A

Explanation

Choice A rationale:

The nurse should include the instruction to wash hands with soap and water for 20 seconds in the teaching. This is a fundamental aspect of hand hygiene in healthcare settings. The rationale for this choice is that proper handwashing with soap and water for at least 20 seconds is the most effective way to remove dirt, debris, and transient microorganisms from the hands. It helps prevent the spread of infections, including those caused by viruses and bacteria.

Choice B rationale:

Wearing sterile gloves when in contact with body fluids is not directly related to hand hygiene education. While wearing gloves is an essential infection control practice, it is not a substitute for proper handwashing. Hand hygiene should be performed before donning gloves and after removing them.

Choice C rationale:

Using alcohol-based cleanser when hands are visibly soiled is not the best instruction for hand hygiene. Alcohol-based hand sanitizers are effective when hands are not visibly soiled. In cases of visible soiling, handwashing with soap and water is recommended to physically remove dirt and contaminants.

Choice D rationale:

Artificial nails should not be worn when performing direct client care as they can harbor microorganisms and make it challenging to clean the hands adequately. The use of artificial nails can increase the risk of transmitting infections to patients, which is why they should be discouraged in healthcare settings.

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A nurse is documenting client care in the nurses' notes and notices that a space was left blank.
Which of the following actions should the nurse take?