In which of the following sections of the progress note should a medical assistant document a patient's chief complaint?
Subjective
Objective
Review of systems
Assessment
The Correct Answer is A
A. Subjective: The chief complaint is a patient-reported symptom or concern and is documented in the subjective section of the progress note. This section includes the patient’s personal perspective and descriptions of their symptoms.
B. Objective: The objective section includes measurable or observable data, such as vital signs and physical examination findings, not the patient’s chief complaint.
C. Review of systems: The review of systems is a systematic approach to obtaining information about the functioning of various body systems but is not specifically where the chief complaint is documented.
D. Assessment: The assessment section contains the provider’s diagnostic impressions and conclusions about the patient’s condition, rather than the chief complaint.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. To ensure accuracy of test results: Quality control ensures that the test results are accurate and reliable, which is crucial for proper diagnosis and treatment.
B. To determine if a test is CLIA-waived: Quality control does not determine CLIA-waived status; it ensures the accuracy and reliability of tests.
C. To enhance instrument productivity: While quality control can indirectly impact productivity by ensuring correct results, it is primarily focused on accuracy and reliability.
D. To monitor the use of instrumentation: Quality control is more focused on test accuracy rather than monitoring the use of instrumentation.
Correct Answer is C
Explanation
Correct answer: C
A. Taking aspirin within 12 hr of testing: Aspirin does not generally impact spirometry results.
B. Using sedatives within 1 hr of testing: While sedatives might affect breathing, they are not commonly noted as a significant factor for spirometry test preparation.
C. Exercising 2 hr prior to testing: Exercise can temporarily affect lung function, so it's advised to avoid vigorous exercise before a spirometry test to ensure accurate results.
D. Eating a heavy meal 4 hr prior to testing: Although a heavy meal might cause some discomfort, it is less likely to affect the spirometry results compared to exercise.
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