After completing a health assessment of the client, which ...

[robinn137]

After completing a health assessment of the client, which information would the nurse need to document in the progress notes as opposed to on the assessment form?
 
  1. Any findings that deviate from expected or normal findings
  2. Detailed follow-up examination of findings that deviate from expected or normal findings
  3. All findings of the health assessment
  4. Nothing, because everything would be documented on the assessment form

Question 2

The nurse is caring for a client in chronic renal failure who is admitted to the hospital to begin peritoneal dialysis. Which manifestation would the nurse need to report to the health care provider immediately?
 
  1. Urine output of 10 mL over the past 4 hours
  2. Potassium level of 5.9 mg/dL
  3. Edema of the ankles bilaterally with 1+ pitting
  4. Slight rales in the base of the right lung

[Chelseyj.hasty]

Answer to Question 1

Correct Answer: 2

The assessment form should be completed using all of the assessment findings. The nurse should perform a detailed follow-up examination of findings that deviated from normal or expected values, and these findings should be documented in the nurse's progress notes and used to create the plan of care.

Answer to Question 2

Correct Answer: 2

The nurse would report unexpected or potentially dangerous findings to the primary care provider. A potassium level of 5.9 is significant, and would need to be reported immediately. Reduced urine output, mild edema of the ankles, or mild rales at the base of a lung are anticipated findings in a client with chronic renal failure prior to dialysis, and would not need to be reported.

[robinn137]

Thank you

[Chelseyj.hasty]

No problemo