After completing the client care and documenting it in the ...

[darbym82]

After completing the client care and documenting it in the progress notes, the nursing student discovered he had written in the wrong chart. The correct action is to:
 
  1. Use white-out over the mistake.
  2. Take a wide permanent marker and blacken out all the documentation.
  3. Put an X through the entire page, identify it as an error, initial, and move on to the correct chart.
  4. Draw a single line through the documentation, write mistaken entry next to the original entry, and initial it.

Question 2

The nurse is doing teaching regarding medication administration for a client who is being discharged. Which of the following instructions should be rewritten for this client?
 
  1. Lasix, 20 mg, po bid
  2. Lasix, 20 mg tablet, twice daily
  3. Lasix, 20 mg by mouth, two times a day a day
  4. Lasix, 20 mg by mouth 8 AM and 2 PM

[C.mcnichol98]

Answer to Question 1

Correct Answer: 4
Rationale 1: Erasure, blotting out, or correction fluid should not be used.
Rationale 2: Erasure, blotting out, or correction fluid should not be used.
Rationale 3: When a mistake is recorded The correction applies to only the erroneous information not the entire page.
Rationale 4: When a mistake is recorded, a line should be drawn through it and the words mistaken entry written above or next to the original entry, then initial or signaturewhichever is agency policy. The original entry must remain visible.

Answer to Question 2

Correct Answer: 1
Rationale: If the discharge plan is given directly to the client and family, it is imperative that instructions be written in terms that can be readily understood. For example, medications, treatments, and activities should be written in layman's terms, and use of medical abbreviations should be avoided. Twice a day should be written out, not abbreviated as bid.