A nurse has completed morning care and assessments and will now document the findings. When documenting care on a client's chart, the nurse should:
A) include personal opinions and feelings that are related to care.
B) use only officially approved abbreviations.
C) completely erase or delete all errors.
D) write a detailed explanation of all reasons for a medical error.
Ans: B
Feedback:
Using incorrect abbreviations is the source of many medical and nursing errors. Personal opinions and feelings should not appear in the legal record. Charted entries are never erased or deleted and details of a medical error are entered on an incident report, not the client's chart.
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