Nurses at a health care facility maintain client records using a ...

[olgavictoria]

Nurses at a health care facility maintain client records using a method of documentation known as charting by exception. Which of the following is a benefit of this method of documentation?
 
  A) It documents assessments on separate forms.
  B) It records progress under problems, intervention, and evaluation.
  C) It provides and refers to client's problem by a number.
  D) It provides quick access to abnormal findings.

Question 2

A nurse charting in the medical record for a client knows that which of the following forms of charting involves writing information about the client and client care in chronological order?
 
  A) Focus charting
  B) SOAP charting
  C) Narrative charting
  D) PIE charting

[katieost]

Answer to Question 1

D
Feedback:
Charting by exception provides quick access to abnormal findings as it does not describe normal and routine information. When using the PIE charting method, assessments are documented on separate forms. The PIE charting method, not charting by exception, records progress under problems, intervention, and evaluation. The client's problems are given a corresponding number in the PIE charting method, which is used in the progress notes when referring to interventions and the client's responses.

Answer to Question 2

C
Feedback:
Narrative charting involves writing information about the client and client care in chronological order. In SOAP charting, everyone involved in the client's care makes entries in the same location in the chart. Focus charting follows a data, action, and response (DAR) model to reflect the steps in the nursing process. PIE charting is a method of recording the client's progress under the headings of problem, intervention, and evaluation.

[olgavictoria]

Thanks for the timely response, appreciate it

[nyrave]

Gracias!