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A nurse enters a notation in a patient's medical record but then discovers that the notation was made in the wrong chart. The nurse correctly:

A.

follows agency policy for correcting the error.

B.

whites out the wrong entry and writes the note in the chart of the correct patient.

C.

removes the page on which the error is located and documents the other correct notes.

D.

blacks out the note to protect the confidentiality of the patient about whom it was written and writes in the margin "wrong patient," his signature, and the date and time.

Answer and Explanation

The Correct Answer is A

A. Follows agency policy for correcting the error.
Following agency policy is the best approach, as it ensures compliance with legal and procedural standards for correcting documentation errors.

 

B. Whites out the wrong entry and writes the note in the chart of the correct patient. Whiting out errors is not permissible, as it can appear as an attempt to alter records and compromises the integrity of documentation.

 

C. Removes the page on which the error is located and documents the other correct notes. Removing pages from a medical record is improper and could be considered tampering with documentation.

 

D. Blacks out the note to protect the confidentiality of the patient about whom it was written and writes in the margin "wrong patient," his signature, and the date and time.
Blacking out notes is not allowed, as it destroys information that should remain legible, even if it was written in error.


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View Related questions

Correct Answer is B

Explanation

A. Speaking in simple sentences, as if to a child. This is inappropriate and could be perceived as patronizing, which may hinder communication. Older adults should be treated with respect, not as children.

B. Speaking slowly in order to allow the patient to process the message. Older adults may need more time to process information, so speaking slowly can aid understanding without appearing patronizing.

C. Addressing him by his first name to encourage a therapeutic relationship. Addressing older adults by their first names may be seen as disrespectful or overly familiar, unless the patient specifically requests it.

D. Standing in the doorway rather than entering the room to give the older adult patient more privacy. Standing in the doorway may create a physical barrier and distance, which can hinder effective communication and rapport.

Correct Answer is ["A","C","D","E"]

Explanation

A. Asking probing questions. Probing questions can feel invasive, leading to discomfort or defensiveness from the patient.

B. Using nonjudgmental remarks. Nonjudgmental remarks foster open communication, so this is not a communication block.

C. Changing the subject. Changing the subject shows disregard for the patient’s thoughts or feelings, which can block effective communication.

D. Using clichés. Clichés can make patients feel as though their concerns are not truly heard or understood.

E. Giving advice. Giving advice without patient input can make the patient feel undervalued and less autonomous.

F. Offering hope. Offering realistic hope and encouragement can actually facilitate communication, as long as it’s not false reassurance.

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