A resident in a skilled nursing facility for a short-term rehabilitation following a hip replacement says to the nurse, "I don't want to have you draw any more blood for those useless tests." When the nurse fails to convince the patient to have the blood drawn, the most appropriate documentation would be:
"Blood not drawn because tests are no longer desired by patient."
"Refuses to have blood drawn; says tests are 'useless. Doctor notified."
"Doctor notified of failure to draw ordered blood work."
"Refuses to have blood drawn. Doctor notified."
The Correct Answer is B
A. "Blood not drawn because tests are no longer desired by patient."
This statement is vague and lacks specific details regarding the patient's exact refusal and the communication with the doctor.
B. "Refuses to have blood drawn; says tests are 'useless.' Doctor notified."
This response documents the patient's refusal with their exact words ("useless") and also notes that the doctor has been informed, which is essential for clear, complete documentation.
C. "Doctor notified of failure to draw ordered blood work."
This documentation lacks the reason for the blood draw failure (patient refusal) and omits the patient’s specific wording.
D. "Refuses to have blood drawn. Doctor notified."
Although this documents the refusal and the doctor’s notification, it omits the patient’s exact words, which can provide additional context for the healthcare team.
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Correct Answer is C
Explanation
A. Defensive response
A defensive response would involve protecting oneself or one's position rather than addressing the patient’s concerns. The nurse’s statement here is more dismissive than defensive.
B. Asking probing questions
Probing questions would involve persistent questioning, which does not apply here, as the nurse is not asking questions but making a dismissive comment.
C. Using clichés
"Every cloud has a silver lining" is a cliché, which may come across as dismissive and minimize the patient’s concerns. Using clichés can make the patient feel unheard and invalidated.
D. Changing the subject
Changing the subject would involve diverting attention to an unrelated topic. The nurse here is not introducing a new topic but is using a cliché instead.
Correct Answer is C
Explanation
A. write down the steps as she performs them.
Writing down the steps may help the patient review later but does not actively engage the patient in learning during the procedure.
B. read the listed steps written on a poster board on the wall.
Reading steps on a poster board can provide visual support but doesn’t actively involve the patient in recalling or practicing the procedure.
C. verbalize each step until the steps are memorized.
Verbalizing each step is an active form of learning that reinforces memory and helps the patient feel more comfortable with the process, making it an effective teaching strategy.
D. close her eyes and envision the process.
Visualization can help with memory, but it may not be as effective as actively verbalizing each step for practical, hands-on tasks.