Author Question: Assessment documentation should include all of the following except a. What the resident said b. ... (Read 29 times)

lunatika · **on:** Jul 11, 2018

Assessment documentation should include all of the following except

a. What the resident said
b. Phone calls to the physician
c. Blood pressure
d. The nurse's observation

Question 2

Marvin Olsen, 86 years old, has been diagnosed as having relocation-related stress. Which of the following are symptoms of relocation trauma?

a. Watching TV and visiting with other residents in the day room
b. Refusing to take a tub bath and washing self at the sink in his room
c. Exhibiting increased confusion and wandering behavior at night
d. Attending all available activities in the facility

Mollythedog · **Reply #1 on:** Jul 11, 2018

Answer to Question 1

B
Assessment documentation includes nursing observations, objectives, measurements, and what the resident did or said. Phoning the physician is an action tool that is not part of the assessment.

Answer to Question 2

C
Increased confusion and wandering are classic symptoms of relocation trauma. Residents who are having trouble adjusting to a new environment more often withdraw and do not become active in facility activities (responses A and D). The refusal to take a tub bath (response B) could be interpreted as a personal choice issue.