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Security and Privacy: While security and privacy are critical in electronic health records (EHR), they do not directly relate to improving documentation efficiency. Security measures protect client data from unauthorized access but do not necessarily enhance the speed of documentation.

Gamification: Gamification involves using game-like elements (e.g., rewards, challenges) to engage users. While it may be useful in staff training, it does not directly facilitate documentation of critical changes in client conditions.

Copy and Paste: While copy-and-paste functionality can save time, it is often discouraged in healthcare documentation due to the risk of carrying forward outdated or inaccurate information.

Providing a detailed SBAR report to the primary nurse: SBAR (Situation, Background, Assessment, Recommendation) is a standard communication tool used among healthcare professionals to ensure continuity of care. Since this report is given to the primary nurse who is part of the healthcare team, it does not violate confidentiality.

Collaborating with the patient care technician for hygiene care: Patient care technicians (PCTs) are part of the healthcare team, and sharing necessary patient information with them to ensure hygiene care does not breach confidentiality.

Discussing the client's medications with the clinical instructor: A clinical instructor is responsible for overseeing student learning and patient safety. As long as the discussion is conducted in an appropriate setting (e.g., away from unauthorized persons), it does not violate confidentiality.

Transient incontinence and increased urine production: While increased urine production is expected, transient incontinence is not a typical finding with furosemide unless the client has preexisting bladder control issues.

Increased urine concentration: Furosemide is a loop diuretic that promotes the excretion of sodium and water, leading to dilute urine rather than concentrated urine.

A risk of urinary tract infections: Furosemide does not directly increase the risk of urinary tract infections (UTIs). UTIs are more common with urinary retention rather than increased urine flow.

"Let me talk to the provider and see what we can do." This response suggests that the nurse might override the provider’s decision or negotiate an unnecessary prescription, which is inappropriate.

"Why do you think you need an antibiotic?" While this question encourages the client to express their thoughts, it may come across as dismissive or challenging rather than supportive.

"I understand your frustration. You need an antibiotic." This statement is incorrect because it reinforces a misconception that antibiotics are needed for viral infections, which can contribute to antibiotic resistance.

89-year-old with dementia and NG tube with continuous tube feeding: While this patient requires monitoring, continuous tube feeding is routine, and there is no indication of immediate distress.

73-year-old with hypoactive bowel sounds one day post-cholecystectomy: Hypoactive bowel sounds are expected after surgery, particularly after abdominal procedures. This does not indicate an emergency.

43-year-old with anorexia and nausea for two days who is tolerating a clear liquid diet: This patient’s condition is stable, and nausea is resolving, making them a lower priority.

Ensure the patient is safe and leave to get them some water: The provider’s verbal statement is not an official order. The student nurse must ensure a written order is in place before implementing dietary changes.

Contact dietary to order the patient a full liquid meal: The student nurse cannot place orders. They must first verify that the provider has documented the order.

Record the information in the patient chart: The student nurse cannot chart an order that has not been officially written by the provider.

A patient who is lying on wrinkled sheets: Wrinkled sheets can cause pressure injuries, but they do not directly lead to shearing.

A patient who is frequently incontinent: Incontinence increases the risk of moisture-associated skin damage and pressure injuries but is not directly related to shearing.

A patient who is noted to have slough tissue: The presence of slough (dead tissue in a wound) indicates existing tissue damage but does not suggest an increased risk of shearing.

Green, soft stool after the patient received antibiotics: Green stool can be a side effect of antibiotics due to changes in gut flora but is not typically concerning.

Large, loose stool after the patient received a laxative: This is an expected outcome of laxative use and is not cause for concern.

Dry, hard stool from a patient receiving opiates: Opiates commonly cause constipation. While this requires management, it is not the most concerning finding.

Administering medications through an NG tube: While NG tubes can introduce bacteria, they are not as high-risk as urinary catheters, which provide a direct route for infection.

Changing a sacral wound dressing: While wounds can become infected, proper wound care techniques minimize risk. Urinary catheters pose a greater risk due to prolonged exposure to bacteria.

Replacing an ostomy appliance: While maintaining hygiene is important, ostomy appliances are not a major source of healthcare-associated infections compared to urinary catheters.

Administering medications through an NG tube: While NG tubes can introduce bacteria, they are not as high-risk as urinary catheters, which provide a direct route for infection.

Changing a sacral wound dressing: While wounds can become infected, proper wound care techniques minimize risk. Urinary catheters pose a greater risk due to prolonged exposure to bacteria.

Replacing an ostomy appliance: While maintaining hygiene is important, ostomy appliances are not a major source of healthcare-associated infections compared to urinary catheters.