A nurse is getting ready for a change-of-shift report. What information should the nurse include?
Medication routine from the medication administration record
Bone scan scheduled for today
Blood pressure from the previous day
Input and output for the shift
The Correct Answer is D
Choice A reason: While medication administration is important, the routine from the MAR is not typically included in a shift report unless there are specific concerns such as missed doses, adverse reactions, or changes in medication orders. The focus should be on current and relevant information.
Choice B reason: Scheduled procedures like a bone scan may be mentioned if they are critical to the client’s care plan or require preparation, but they are not the primary focus of a shift report unless they impact immediate nursing care.
Choice C reason: Vital signs from the previous day are outdated for a shift report. The report should include the most recent and relevant data to guide the incoming nurse’s care decisions.
Choice D reason: Input and output for the shift are essential components of the shift report. They provide insight into the client’s fluid balance, renal function, and potential complications such as dehydration or fluid overload, which are critical for ongoing assessment and care planning.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Secondary prevention focuses on early detection and prompt intervention to prevent progression of disease. Scheduling a mammogram for someone with a family history of breast cancer is a classic example of secondary prevention, as it aims to detect cancer early before symptoms arise.
Choice B reason: Not scheduling tests for an asymptomatic client contradicts the principles of secondary prevention, which often involves screening asymptomatic individuals to catch disease early.
Choice C reason: An echocardiogram for a client with known heart failure is part of tertiary prevention, which involves managing established disease to prevent complications and improve quality of life.
Choice D reason: Administering an influenza vaccine is an example of primary prevention, which aims to prevent disease before it occurs.
Correct Answer is D
Explanation
Choice A reason: Delaying documentation until the end of the shift increases the risk of forgetting details, introduces inaccuracies, and compromises the legal integrity of the record. Timely documentation is essential for continuity of care and legal protection.
Choice B reason: Using correction fluid is strictly prohibited in medical documentation. Errors should be corrected by drawing a single line through the incorrect entry, writing “error,” and initialing it. This maintains transparency and legal accountability.
Choice C reason: Abbreviations should be used cautiously and only if they are approved by the institution. Overuse or use of non-standard abbreviations can lead to misinterpretation and errors in care.
Choice D reason: Including the date and time on all entries is a fundamental legal and professional requirement. It ensures chronological accuracy, supports continuity of care, and provides a clear timeline for clinical decisions and interventions.
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