Which entry will require follow-up by the nurse manager? 0800 Patient states, "Fell out of bed." Patient found lying by bed on the floor
Legs equal in length bilaterally with no distortion, pedal pulses strong, leg strength equal and strong, no bruising or bleeding. Neuro checks within normal limits. States, "Did not pass out." Assisted back to bed. Call bell within reach. Bed monitor on. -------------------Jane More, RN 0810 Notified primary care provider of patient's status. New orders received. -------------------Jane More, RN 0815 Portable x-ray of L hip taken in room. States, "I feel fine." -------------------Jane More, RN 0830 Incident report completed and placed on chart. -------------------Jane More, RN a. 0800
b. 0810
c. 0815
d. 0830
D
Note that you do not include mention of the incident report in the patient's medical record. Instead you document in the patient's medical record an objective description of what happened, what you observed, and follow-up actions taken. It is important to evaluate and document the patient's response to the error or incident. Always contact the patient's health care provider whenever an incident happens.
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The nurse is reviewing the results of the patient's laboratory findings and notes an elevated C-reactive protein (CRP). What does this indicate?
a. The patient had a myocardial infarction. b. The patient has inflammation in the body. c. The patient has reduced cardiac output. d. The patient's diet is high in cholesterol.
When the caregiver is frustrated and complaining of being overwhelmed, the nurse can assist by (select all that apply):
1. taking over the care. 2. referring the caregiver to a support group. 3. seeking assistance from a home health agency. 4. listening to the caregiver's concerns. 5. assisting in making a daily schedule for the caregiver to follow.
Outcome criteria for nursing diagnoses are patient-centered, time-specific, and measurable. They are classified into three domains: cognitive, affective, and psychomotor. The focus of the outcome criteria is the patient, not the nurse. While the outcome c
1. Document 2. Reassess the patient 3. Measure vital signs 4. Provide report to the charge nurse
Which of the following clients would be most at risk for the development of osteomalacia?
A. 72-year-old man with congestive heart failure B. 55-year-old woman with Laënnec's cirrhosis C. 22-year-old woman with type 1 diabetes D. 45-year-old woman with asthma