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Author Question: Client is wheezing and experiencing some dyspnea on exertion. This is an example of: A. The S in ... (Read 119 times)

natalie2426

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Client is wheezing and experiencing some dyspnea on exertion. This is an example of:
 
  A. The S in SOAP documentation
  B. FOCUS documentation
  C. The P of PIE
  D. The R in DAR documentation

Question 2

For intestinal tube placement the nurse should:
 
  A. Remove the guide wire after the tube is inserted
  B. Measure from the nose to the earlobe to the xiphoid process
  C. Apply skin adhesive to the nose and anchor the tube with tape
  D. Place the client on his or her right side until placement is confirmed with an x-ray film



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sultansheikh

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Answer to Question 1

C
C. This datum is an example of the P of PIE because it describes the problem.
A. The S in SOAP documentation represents subjective data (verbalizations of the client).
B. FOCUS charting does not concentrate only on problems. It is structured according to a client's concerns.
D. The R in DAR documentation is the response of the client. This situation describes the client's problem, not the client's response.

Answer to Question 2

C
C. Temporarily anchor tube to the nose with a small piece of tape, and check placement of tube.
A. Leave guide wire or stylet in place until correct position is ensured by x-ray film. Never attempt to reinsert a partially or fully removed guide wire or stylet while feeding tube is in place. This can cause perforation of the tube and injure the client.
B. Measure distance from tip of nose to earlobe to xiphoid process of sternum. Add additional 20 to 30 cm (8 to 12 inches) for NI tube.
D. Researchers indicate that placing the patient on the right side does not promote passage of the tube into the small intestine.





 

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