The nurse is caring for a trauma patient who has just arrived in the emergency room.
The nurse listens to the patient's lung sounds, palpates the patient's peripheral pulses, and obtains vital signs.
What is the best description of the nurse's actions?

Choice A rationale

An incident report primarily focuses on documenting the facts of an event, not on preventing lawsuits. While a thorough report might indirectly help in legal defense by providing a clear record, its main purpose isn't legal protection. Legal strategies are separate from the incident reporting process.

Choice B rationale

Incident reports are crucial for a healthcare facility's quality improvement initiatives. By systematically documenting occurrences like patient falls, the hospital can analyze trends, identify potential risks and contributing factors, and implement strategies to prevent similar incidents in the future, thereby enhancing patient safety and care quality.

Choice C rationale

While incident reports from various units might be reviewed and compared as part of a broader quality improvement effort, the primary reason for completing an individual incident report is not solely for comparing fall rates between units. The immediate goal is to document the specific incident and identify local contributing factors.

Choice D rationale

Incident reports are designed to document events objectively. They are not primarily used as a basis for disciplinary action against a nurse. Disciplinary processes would involve a separate investigation to determine if negligence or policy violations occurred, based on various sources of information, not just the incident report.

Choice A rationale

The orientation phase of the interview typically involves introducing oneself, explaining the purpose of the interview, and establishing rapport with the patient. Asking about the drug list occurs after this initial introduction.

Choice B rationale

The termination phase is the concluding part of the interview, where the nurse summarizes key information and discusses the plan of care. Medication history is gathered much earlier in the assessment.

Choice C rationale

The working phase is where the nurse actively collects data about the patient's health history, current condition, medications, and other relevant information. Asking about the drug list, including herbal supplements and over-the-counter medications, is a key component of this data gathering process.

Choice D rationale

The pre-interaction phase occurs before meeting the patient and involves the nurse reviewing available information such as the patient's chart. The actual questioning of the patient happens later.

Choice E rationale

The evaluation phase occurs after interventions have been implemented to assess their effectiveness. It is not the phase where the initial assessment and data collection, including medication history, take place. .