The nurse knows that documentation should record the interventions and the care given to the client.
What is the rationale?
It is a legal record of accountability for protection of the client and the nurse.
It supports confidentiality and privacy and should never.
It provides continuous reference for all care providers to refer to.
it provides a framework for clients rights and records if they are violated.
The Correct Answer is A
It is a legal record of accountability for the protection of the client and the nurse. This means that documentation provides evidence of the assessments and interventions that have been undertaken by the nurse and can be used to defend the nurse in case of a lawsuit or a complaint. Documentation also supports the provision of safe, high-quality patient care by facilitating continuity of care and communication among health care providers.
Choice B is wrong because it is incomplete and misleading. Documentation supports confidentiality and privacy, but it should never be shared without the client’s consent or a legal authority.
Choice C is wrong because it is too narrow. Documentation provides continuous reference for all care providers to refer to, but it also has other purposes such as quality improvement, research, education and legal protection.
Choice D is wrong because it is inaccurate. Documentation does not provide a framework for clients rights, but rather reflects how the nurse respects and upholds those rights in practice. Documentation also records if clients rights are violated, but this is not the main rationale for documentation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
“Tell me what your pain feels like.” This question allows the nurse to assess the quality of pain, which is one of the characteristics of pain that can help determine its cause and treatment. Quality of pain refers to how the client describes the pain, such as sharp, dull, burning, throbbing, etc.
Choice A is wrong because it assesses the intensity of pain, not the quality. Intensity of pain is how much the pain hurts on a scale of 0 to 10 or using other methods.
Choice C is wrong because it assesses the precipitating factors of pain, not the quality. Precipitating factors are events or activities that trigger or worsen the pain.
Choice D is wrong because it assumes a specific quality of pain without asking the client. The nurse should not suggest words to describe the pain, but rather let the client use their own words.
Correct Answer is B
Explanation
This is because anti-embolism stockings are designed to prevent swelling and blood clots in the legs by applying graduated compression, which is tighter around the ankle and looser as it moves up the leg. Applying the stockings in the morning before any swelling occurs ensures a proper fit and optimal blood flow.
Choice A is wrong because massaging the legs can dislodge a blood clot and cause a pulmonary embolism.
Choice C is wrong because wetting the stockings can make them harder to apply and reduce their effectiveness.
Choice D is wrong because removing the stockings before bathing can increase the risk of swelling and clotting, and applying fresh ones afterward can be difficult and uncomfortable.
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