A nurse is documenting information related to a client's condition. When documenting this information in the paper chart, the nurse makes an error documenting vital signs, entering 86/132. What is the best technique for recording the error made in documentation?

Cross out 86/132 using a single line

Cross out 68/132 with correction fluid to obliterate what has been written

Erase the incorrect statement and replace it with the correct one

Cross out the wrong statement in a way that is not readable

Answer and Explanation

The Correct Answer is A

A. Cross out 86/132 using a single line: The correct way to correct an error in paper documentation is to draw a single line through the incorrect entry so that it remains legible. The nurse should then write the correct information nearby, initial it, and include the date and time of the correction.

B. Cross out 68/132 with correction fluid to obliterate what has been written: Using correction fluid is not acceptable in legal or medical records. It obscures the original entry, which violates documentation standards and can raise concerns about record tampering.

C. Erase the incorrect statement and replace it with the correct one: Erasing chart entries is prohibited, as it removes the original data completely. This action compromises the integrity and traceability of medical documentation.

D. Cross out the wrong statement in a way that is not readable: Making the incorrect entry unreadable is improper, as it prevents verification of the original documentation. All corrections must be transparent and legible to maintain legal and professional standards.

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Correct Answer is C

Explanation

A. Human dignity: This refers to respecting the inherent worth of all individuals, including honoring patient preferences and privacy, rather than admitting one's own mistakes.

B. Social justice: Social justice involves promoting fairness and equity in health care delivery and access. While important, it doesn't capture the personal ethical responsibility demonstrated here.

C. Integrity: Integrity is demonstrated by being honest and accountable for one’s actions, including admitting errors, upholding professional standards, and taking responsibility to ensure safe and ethical care.

D. Altruism: Altruism is the concern for the well-being of others, often seen in selfless acts to help patients or colleagues, but it does not specifically reflect the act of reporting one’s own error.

A. Place the heel of the hand on the greater trochanter and the index finger on the anterior superior iliac crest. B. Measure two fingerbreadths below the acromion process. C. Ensure to find a place 2 inches away from the umbilicus and free of bruising. D. Measure a handbreadth above the knee and a handbreadth below the greater trochanter.

Correct Answer is D

Explanation

A. Place the heel of the hand on the greater trochanter and the index finger on the anterior superior iliac crest: This method is used to locate the ventrogluteal site, not the vastus lateralis.

B. Measure two fingerbreadths below the acromion process: This technique is used to identify the deltoid muscle for IM injections. It is not appropriate when the vastus lateralis is the intended site for medication administration.

C. Ensure to find a place 2 inches away from the umbilicus and free of bruising: This description refers to a subcutaneous injection in the abdomen, commonly used for medications like insulin or heparin, not for IM injections.

D. Measure a handbreadth above the knee and a handbreadth below the greater trochanter: This is the correct technique for locating the vastus lateralis muscle. It ensures the injection is given in the thickest part of the muscle, minimizing the risk of nerve or blood vessel injury.

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A nurse is documenting information related to a client's condition. When documenting this information in the paper chart, the nurse makes an error documenting vital signs, entering 86/132. What is the best technique for recording the error made in documentation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

In the delivery of care the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that the nurse has made. The nurse is most clearly demonstrating which professional value?

Correct Answer is C

Explanation

A nurse is preparing to administer ceftriaxone 300 mg IM into the right vastus lateralis. Which of the following actions should the nurse take to locate the site of injection?

Correct Answer is D

Explanation

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