A nurse in a long-term care facility is caring for a client who received a superficial burn from a heating pad that malfunctioned. After completing an incident report, which of the following actions should the nurse take?
Record in the nurse's notes that an incident report was filed.
Give the family a copy of the incident report.
Document the facts about the incident in the medical record.
Place a copy of the incident report in the medical record.
The Correct Answer is C
A. While the nurse's notes may include observations about the client's condition, recording that an incident report was filed does not provide pertinent details regarding the client's care and is not appropriate.
B. Incident reports are confidential documents and should not be shared with the client's family, so providing a copy of the report is inappropriate.
C. Documenting the facts about the incident in the medical record is essential to provide a complete account of the client's care and any resulting changes or observations. This documentation is important for continuity of care and legal purposes.
D. Incident reports should not be placed in the medical record, as they are separate documents intended for internal review and quality assurance purposes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D,C,A,B
Explanation
Rationale
- Situation: The client has COPD and is experiencing an acute exacerbation.
- Background: The client has a history of COPD and has been experiencing increasing shortness of breath.
- Assessment: The client's temperature is 39.5°C (103.1°F) and is experiencing shortness of breath.
- Recommendation: Contact the client's provider for a prescription for a sputum culture.
Correct Answer is A
Explanation
A. Reviewing evidence-based literature is essential to understand best practices in shift reporting and can inform the development of effective interventions. This foundational step helps ensure that any proposed changes are supported by research and proven methods.
B. While organizing a task force can be beneficial, it should occur after understanding the current best practices, as the task force's efforts would be better guided with existing evidence.
C. Creating a new reporting process without first gathering information or reviewing best practices may result in ineffective or unnecessary changes.
D. Developing a strategy to alert nurses is important, but it should be based on informed decisions derived from literature and data analysis, which should come first.
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