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If an agency is using computer-assisted charting, the nurse is responsible for:

A.

Guarding the confidentiality of the patient record by not leaving the patient screen "on" if he leaves the terminal.

B.

Learning the passwords of the staff nurses and primary care providers so that they can communicate with one another.

C.

Choosing whether he will use the computer to help in documentation or continue to use traditional paper documentation.

D.

Patient education to input information about herself, such as intake and output or symptoms the patient may experience.

Answer and Explanation

The Correct Answer is A

A. Guarding the confidentiality of the patient record by not leaving the patient screen "on" if he leaves the terminal. Protecting patient confidentiality is essential in electronic charting to prevent unauthorized access.

 

B. Learning the passwords of the staff nurses and primary care providers so that they can communicate with one another. Sharing or learning others' passwords violates security protocols and confidentiality rules.

 

C. Choosing whether he will use the computer to help in documentation or continue to use traditional paper documentation. In facilities using electronic charting, all staff are typically required to use the system to maintain consistent, accessible records.

 

D. Patient education to input information about herself, such as intake and output or symptoms the patient may experience. Patients typically do not have access to chart directly into their medical records.


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Correct Answer is B

Explanation

A. Saving the extra time it would take to mail the information.
The purpose of asking the patient to repeat information is not about saving time but to ensure accurate understanding.

B. Verifying that the patient understands the information.
Asking the patient to repeat the information confirms that they understood it correctly, which is essential in promoting effective communication and preventing misunderstandings.

C. Acting in a cautious way to avoid charges of negligence. While caution is involved, the primary purpose is to ensure understanding rather than legal protection.

D. Testing the patient's intelligence and memory.
This is not a test of intelligence or memory but rather a verification of understanding.

Correct Answer is C

Explanation

A. "Come and get me if Mr. Jones has a high heart rate." This statement lacks specificity, as “high heart rate” is vague. The assistant may not know what range constitutes “high.”

B. "I need to know if Mr. Jones' blood pressure is elevated."
This statement is also too vague, as the assistant may not understand what is considered "elevated."

C. "If Mr. Jones' heart rate is greater than 100, let me know."
This direction is clear and specific, providing a measurable parameter for the assistant to follow, making it the best option.

D. "Let me know if Mr. Jones' temperature is high."
"High" is vague, as it does not provide a specific value or range for temperature.

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