Informatics / Health Information

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A nurse is attending a job fair at the local community center and stops at a booth that is demonstrating technology for client care. While touring the booth, the nurse meets an informatics nurse specialist (INS). Being unfamiliar with this position, the nurse asks the INS, "How did you get this position?" Which response by the nurse would be most appropriate? "I am required to have a bachelor's degree in nursing." "I've had graduate-level education focusing on informatics." "I was involved in getting our electronic health record off the ground." "I have a doctorate in nursing with a minor in computer technology."

"I've had graduate-level education focusing on informatics." An informatics nurse specialist (INS) is a registered nurse with formal graduate-level education in the field of informatics. The INS is often responsible for strategy development, implementation, and maintenance and evaluation of clinical systems requiring collaboration with multiple disciplines. Nursing informatics education typically consists of a master's degree program, although some universities offer a post-master's program for those who already possess another graduate nursing degree. An informatics nurse (IN) is a registered nurse with an interest or experience in an informatics field. This may be a nurse who has assisted with the implementation of an EHR and is considered a "superuser," with training being primarily on the job.

The unlicensed nursing assistant is viewing the electronic medical record of an assigned client. When the assistant tries to access notes made by the social worker, an error message appears on the screen that reads, "You are not authorized to view this information." The assistant questions the nurse about this message. What response would the nurse make? "Why are you trying to access that infromation on the client?" "You should contact the information technology department to let them know." "You are not authorized to view all of the details on the client." "I can pull up the data for you under my log-in information."

"You are not authorized to view all of the details on the client." To protect confidentiality, it is important to control the type of information that personnel in various departments can retrieve. Unlicensed nursing assistants can retrieve information from the medical records, but they cannot view information from the social worker. The reason the assistant wants to view that information is irrelevant. The information technology department does not need to be notified, because there is not a problem with the nursing assistant's log-in information. The nurse should not pull up the data for the assistant, because it is information that the assistant is not authorized to have.

A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use? Ability to provide services in a variety of locations Improvement in therapeutic relationship Ensured quality of care Ability to provide high-intensive services for many mental illnesses

Ability to provide services in a variety of locations E-mental health services can be delivered in a variety of locations, such as schools, places of employment, and clinics. Although the use of e-mental health applications is increasing, concerns have been expressed about using the Internet for the delivery of mental health care. Difficulties may occur in developing a therapeutic client-provider relationship via the Internet. There are concerns about the ability to ensure the quality of online mental health interventions. Client privacy and confidentiality may be compromised in a web-based, e-mental health application. In addition, the Internet is often not available to subpopulations of clients with chronic and severe mental illnesses who require high-intensity services, such as those diagnosed with schizophrenia.

An informatics nurse specialist is using technology to collect health care-related data from multiple sources in an attempt to transform that data to answer questions. The nurse plans to use this data to assist with the management of clients regardless of the setting. The nurse is using which area of analytics? Data visualization Predictive analytics Big Data Population health

Big Data Big Data comprises the accumulation of health care-related data from various sources, combined with new technologies that allow for the transformation of data to information, to knowledge, and ultimately to wisdom. Delivering the required analytics functionality to manage clients, regardless of the setting, necessitates the adoption of Big Data technologies into our practice. Data visualization is the presentation of data in a pictorial or graphical format. Predictive analytics encompasses a variety of statistical techniques that analyze current and historical facts to make predictions about future or otherwise unknown events. Population health addresses the health status and health issues of aggregate populations. It brings significant health concerns into focus and addresses ways in which communities, health care providers, and public health organizations can allocate resources to overcome the problems that drive poor health conditions in the population. Population health analytics can help organizations identify clients at risk of needing additional assistance to manage their health.

Glulisine insulin is prescribed to be administered to a client before each meal. To assist the day-shift nurse who is receiving the report, the night-shift nurse gives the morning dose of glulisine. When the day-shift nurse goes to the room of the client who requires glulisine, the nurse finds that the client is not in the room. The client's roommate tells the nurse that the client "went for a test." What should the nurse do next? Bring a small glass of juice, and locate the client. Call the client's health care provider (HCP). Check the computerized care plan to determine what test was scheduled. Send the nurse's assistant to the x-ray department to bring the client back to the room.

Check the computerized care plan to determine what test was scheduled. Glulisine is a rapid-acting insulin with an action onset of 15 minutes. The client could experience hypoglycemia with the insulin in the bloodstream and no breakfast. It is not necessary to call the client's HCP; the nurse should determine what test was scheduled and then locate the client and provide either breakfast or 4 oz (120 mL) of fruit juice. To bring the client back to the room would be wasting valuable time needed to prevent or correct hypoglycemia.

An informatics nurse is demonstrating how to use an updated version of an electronic documentation system to a group of staff nurses. The nurse shows the staff that they can follow the same steps that they used with the previous system but need to add one additional final step to the process. The informatics nurse's actions reflect which concept of usabilty? Simplicity Consistency Naturalness Minimizing cognitive load

Consistency Consistency involves a user's prior experience. The more users can apply prior experience to a new system, the lower the learning curve, the more effective their usage, and the fewer their errors. The fact that the staff can follow the same steps as before and add only one additional step indicates that the system is consistent. Simplicity in design refers to everything from lack of visual clutter and concise information display to inclusion of only functionality that is needed to effectively accomplish tasks. A "less is more" philosophy is appropriate, with emphasis being given to information needed for decision making. Naturalness refers to how automatically "familiar" and easy to use (intuitive) the application feels to the user. Minimizing cognitive load involves presenting all the information needed for the task at hand so that it is organized by meaningful relationships for the user.

Which are benefits of using the nursing intervention classification (NIC) system for the development of interventions? Select all that apply. Creation of a standardized language Assistance in determining the cost of services that nurses provide Demonstration of the impact of nurses Justifcation of the productivity of the nursing staff Determination of which nursing actions the nurse may delegate

Creation of a standardized language Assistance in determining the cost of services that nurses provide Demonstration of the impact of nurses The NIC provides a form of standardized language for use by nurses. Additionally, the NIC helps to expand the knowledge of similarities and differences across nursing diagnoses and explore nursing care information systems. Use of this model aids in determining the costs ofterm-17 services that nurses provide and demonstrating the impact of nurses on overall health care costs. Use of acuity and workload management tools, not the NIC, aids in justifying staffing levels based on productivity. State nurse practice acts, not the NIC, help determine which nursing actions the nurse may delegate.

An informatics nurse specialist is working on a team that is considering a new technological system for the facility. Which aspect would be most important for the team to do as the first step? Determine the need or problem to be solved Identify the use of standard terminology Conduct testing of the system Train those who will be using the system

Determine the need or problem to be solved Before considering the use of any new technology or an update to the system, analysis and planning must occur. This involves determining the need for the technology or update or identifying the problem to be solved. Once that step is completed, then design (such as using standard terminology), testing and training would occur.

Which are appropriate actions for protecting clients' identities? Select all that apply. Orient computer screens toward the public view. Ensure that clients' names on charts are visible to the public. Document all personnel who have accessed a client's record. Place light boxes for examining X-rays with the client's name in private areas. Have conversations about clients in private places where they cannot be overheard.

Document all personnel who have accessed a client's record. Place light boxes for examining X-rays with the client's name in private areas. Have conversations about clients in private places where they cannot be overheard. Documenting all personnel who have accessed a client's record, placing light boxes for examining X-rays with the client's name in private areas, and having conversations about clients take place in private where they cannot be overheard are useful strategies to limit casual access to the identity of clients and health informatics. Orienting computer screens toward the public view and visibly displaying clients' names on charts are incorrect, as these are breaches of patient confidentiality.

An informatics nurse specialist is working as part of a team that will be developing and implementing a new client assessment tool. During which phase of the system development lifecycle would the team be integrating information about workflow patterns, standard terminology, and recommendations for screen layout from supportive research? Analyze and plan Design and build Test Train

Efficient interactions Efficient interactions is demonstrated by actions that facilitate efficient user interactions. An example is to minimize the number of steps it takes to complete tasks and to provide shortcuts for use by frequent and/or experienced users. Consistency involves the ability of the users to apply prior experience to a new system so that the lower the learning curve, the more effective their usage, and the fewer their errors. Naturalness refers to how automatically "familiar" and easy to use (intuitive) the application feels to the user.

Which healthcare trends should the nurse include when speaking about the efficiency of today's healthcare system at a community health fair? (Select all that apply.) Discuss the expansion of genetic research. Encourage the increase use of outpatient and ambulatory services. Emphasize the need to focus on health promotion and prevention. Explain how physicians are controlling healthcare decision making. Provide information on nationally linked computerized medical record systems.

Encourage the increase use of outpatient and ambulatory services. Emphasize the need to focus on health promotion and prevention. Some of today's trends that increase efficiency in the healthcare system include a shift toward outpatient and ambulatory services and a model of health promotion and preventive care, which help to achieve cost-effectiveness. Also, the increase in technology using a computerized medical record system allows practitioners and consumers to access healthcare information and resources more efficiently and effectively. Physicians no longer control all the healthcare decision making, allowing insurance companies to play an increasingly stronger role. While the expansion of genetic research is a current healthcare trend, it does not impact the efficiency of the healthcare system.

Several nurses on the unit meet with the informatics nurse specialist about some concerns that they have with the current clinical information system. The nurses mention that the layout of the screen is such that it causes strain on the eyes when using it for more than short periods of time. They also mention that because the system requires repetitive clicking to complete one task, they are concerned about repetitive-use injuries when multiple tasks need to be completed. The informatics nurse specialist takes this information back to the technology team and they develop potential solutions to address these issues. The informatics nurse specialist is demonstrating which ANA informatics competency? Environmental health Leadership Implementation Outcomes identification

Environmental health The nurses are voicing concerns related to ergonomics, which is reflected by the competency of environmental health. The competency of leadership is reflected by activities such as mentoring and promoting organizational goals and the strategic plan. The competency of implementation is reflected by activities such as partnering with the healthcare consumer, healthcare team and others to get the plan into motion on time, within budget and within the plan's requirements. The competency of outcomes identification is reflected by activities such as identifying expected goals based on the healthcare consumer, healthcare worker, and others based on the situation.

An informatics nurse specialist is teaching a group of health care providers about the different capabilities available for using electronic information and telecommunications technologies. When describing telehealth, which service would the nurse address as being supported? Select all that apply. Long-distance imaging review Videoconferencing Provider training Administrative meetings Patient health-related education

Long-distance imaging review Videoconferencing Provider training Administrative meetings Patient health-related education Telehealth refers to the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, client and professional health-related education, public health, and health administration. Technologies include videoconferencing, long distance imaging review, streaming media, and terrestrial and wireless communications" (HRSA, 2015). Telehealth can involve more than just clinical services; it can also include remote nonclinical services such as provider training, administrative meetings, and continuing medical education

A facility is considering the addition of an alert system to the current electronic documentation system. The goal is to identify clients at risk for post-operative complications based on client data. A team consisting of an informatics nurse specialist, information technology experts, and nurses work on this. The team is currently in the "analyze and plan" phase of the system development lifecycle. Which activity would the team be involved with at this time? Select all that apply. Identifying the specific purpose for this system Collecting data to determine the seriousness of postoperative complications Identifying the need for a entirely separate system for this task Evaluating how the system might affect the current electronic documentation system Assessing how the system can be incorporated into the nurses' current workflow patterns

Identifying the specific purpose for this system Collecting data to determine the seriousness of postoperative complications Evaluating how the system might affect the current electronic documentation system Assessing how the system can be incorporated into the nurses' current workflow patterns Before considering the employment of any type of new technology or an update to a system already in place, analysis and planning must take place. Activities that may be involved include: determining the purpose of the new technology or change to the current technology; identifying the problem to be solved; evaluating the data available to support how serious the problem is; evaluating how the system's use will be incorporated into the current workflow of the nurse; and how it will affect the overall usability and experience with the EHR.

A nurse caring for a client being treated by three physicians uses the source-oriented format for documentation. What are the benefits of using this format of documentation? Information is documented in separate forms by each healthcare professional. It is a unified, cooperative approach for resolving the client's problems. It is organized at one location according to the client's healthcare problems. It is compiled to facilitate communication among healthcare professionals.

Information is documented in separate forms by each healthcare professional. Source-oriented documentation is a record organized according to the source of documented information. This type of record contains separate forms on which healthcare personnel make written entries about their own specific activities in relation to the client's care. The problem-oriented method of recording demonstrates a unified, cooperative approach for resolving the client's problems. Source-oriented records are organized at numerous locations; there is not one location for information. The problem-oriented record is compiled to facilitate communication among healthcare professionals.

An informatics nurse specialist is interviewing several nurses who have participated in testing a new electronic assessment tool. The nurses report that the tool "feels so familiar, like we know exactly what it is that we're supposed to do." The nurse specialist interprets this as indicating which concept? Naturalness Consistency Simplicity Forgiveness

Naturalness Naturalness refers to how automatically "familiar" and easy to use (intuitive) the application feels to the user. Consistency involves the user's ability to apply prior experience to a new system. The more that users can apply prior experience to a new system, the lower the learning curve, the more effective their usage, and the fewer their errors. Simplicity involves design and refers to everything from lack of visual clutter and concise information display to inclusion of only functions that are needed to effectively accomplish tasks. Forgiveness means that a design allows the user to discover it through exploration without fear of disastrous results.

Which statements are true about informatics in nursing practice? Select all that apply. Computers do not help with communication, but deter it because of the lack of personal interaction. Informatics only involves documentation of timely and accurate charting. Nurses should value technologies that support error prevention and care coordination. The use of informatics can help manage knowledge and mitigate error. Utilization of information services helps to support decision making.

Nurses should value technologies that support error prevention and care coordination. The use of informatics can help manage knowledge and mitigate error. Utilization of information services helps to support decision making. Traditionally, documentation consisted of timely and accurate charting. However, the QSEN updated definition is expanded and calls for using information and technology to communicate, manage knowledge, mitigate error, and support decision making. Nurses should value technologies that support error prevention and care coordination.

A computerized information system developed to classify client outcomes is the: NANDA-International list Nursing Outcome Classification system International Classification of Diseases Clinical Care Classification System

Nursing Outcome Classification system The Nursing Outcome Classification system organizes outcomes according to categories, classes, labels, indicators, and measurement activities. The remaining options do not classify client outcomes. NANDA-International is an organization that develops standardized terminology for nursing diagnosis to ensure client safety and improve client outcomes. The International Classification of Diseases is a classification system for classifying diseases according to diagnosis codes. The Clinical Care Classification System is a standardized system of codes used to label discrete components of nursing practice.

The nurse on the surgical unit is passing 0900 medications to a client using an electronic medication administration record (eMAR). Place the medication steps in the correct sequential order (from first to last) for safe medication administration by the nurse. All options must be used. 1Open the computer program and enter the user ID and password. 2Select the correct client from the list of clients. 3Access the client's eMAR and select/prepare the medication(s) for 0900. 4Verify the client's name, birthday, and armband against the eMAR. 5Administer and document the medications in the eMAR. 6Log out of the client's eMAR and monitor the client for any reactions.

Open the computer program and enter the user ID and password. Select the correct client from the list of clients. Access the client's eMAR and select/prepare the medication(s) for 0900. Verify the client's name, birthday, and armband against the eMAR. Administer and document the medications in the eMAR. Log out of the client's eMAR and monitor the client for any reactions.

An informatics nurse specialist is involved with implementing strategies to improve the performance of the clinical information system being used. As part of this process, the nurse specialist is working on updating the plans of care in the system to reflect changes to a procedure based on new evidence. The nurse is also working to streamline the display screens to reduce the need to document the same information in three different areas. The nurse specialist is addressing which aspect of the system? Usability Optimization Standard terminology Interoperability

Optimization Optimization commonly includes strategies to improve processes, maximize effective use, reduce errors, and eliminate workflow inefficiencies. Updating and streamlining reflect such strategies. Usability refers to the ease of use of the system. Standard terminology refers to the uterm-16se of specific data entry elements that allow the development of reports and data. Interoperability reflects the ability of the system to share data across health care systems.

An informatics nurse is part of a team that is testing a new electronic health record system. The testing involves large groups of health care providers who will be using the system. During this testing, the system stalls and fails to respond when large numbers of providers are using the system at the same time. Which phase of testing is being conducted? Integration Function Performance User acceptance

Performance Performance testing is more technical and ensures proper functioning of the system when there are high volumes of end users or care providers using the system at the same time. Can it handle the load? Function testing uses test scripts to validate that a system is working as designed for one particular function. Integration testing uses test script to validate that a system is working as designed for an entire workflow that integrates multiple components of the system. User acceptance testing occurs when the nurse (or other system end user) "test-drives" the new system or new functions of the EHR to ensure it's working as designed.

A nurse is reviewing the medical record of a client at the clinic. The nurse notes that the medication and dosage prescribed for the client was based on information gathered about the client's genetic makeup from the electronic health record. The nurse interprets this as: Genetics Genomics Pharmacogenomics Telehealth

Pharmacogenomics Pharmacogenomics uses information about a person's genetic makeup, or genome, to choose the drugs and drug doses that are likely to work best for that particular person. Genetics scrutinizes the functioning and composition of the single gene. Genomics addresses all genes and their interrelationships in order to identify their combined influence on the growth and development of the organism. Telehealth refers to the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, client and professional health-related education, public health, and health administration. Technologies include videoconferencing, long distance imaging review, streaming media, and terrestrial and wireless communications and can involve more than just clinical services; it can also include remote nonclinical services such as provider training, administrative meetings, and continuing medical education.

The certified nurse practitioner planning discharge for a patient with congestive heart failure (CHF) wants to prevent readmission to the hospital within 30 days. Which method involves recent advances in health care monitoring capabilities? Planning to monitor the patient at home using the Internet, Web cam, and cellular phone Arranging for a home-based health care multidisciplinary team to visit the client's home after discharge Providing the client with a home scale and instructions to assess and record weight at the same time each day Assisting the client to install an application on their smartphone to track dietary sodium levels

Planning to monitor the patient at home using the Internet, Web cam, and cellular phone Telehealth has emerged from recent advances in technology to allow nurses to monitor clients at home using telephone, computers, Internet resources, and Web cams. Referral to a home care agency does not involve advances in health care monitoring capabilities. Daily weight monitoring is essential for clients with CHF; however, it does not include advances in client monitoring. The smartphone application is installed to monitor sodium intake; this intervention does not allow for an exchange of information between client and nurse.

Which are uses of documentation in client records? Select all that apply. Quality improvement Research Decision analysis Financial reimbursement Market cost analysis Predictive outcome documentation

Quality improvement Research Decision analysis Financial reimbursement Quality improvement, research, decision analysis, and financial reimbursement are all uses for documentation. Market cost analysis and predictive outcome documentation are not uses for documentation.

A nurse has received change-of-shift-report and is briefly reviewing the documentation about a client in the client's medical record. A recent entry reads, "Client was upset throughout the morning." How could the charting entry be best improved? The entry should include clearer descriptions of the client's mood and behavior. The entry should avoid mentioning cognitive or psychosocial issues. The entry should list the specific reasons that the client was upset. The entry should specify the subsequent interventions that were performed.

The entry should include clearer descriptions of the client's mood and behavior. Entries in the medical record should be precise, descriptive, and objective. An adjective such as "upset" is unclear and open to many interpretations. As such, the nurse should elaborate on this description so a reader has a clearer understanding of the client's state of mind. Stating the apparent reasons that the client was "upset" does not resolve the ambiguity of this descriptor. Cognitive and psychosocial issues are valid components of the medical record. Responses and interventions should normally follow assessment data but the data themselves must first be recorded accurately.

An informatics nurse specialist is partnering with the health care team to implement a planned update to the clinical information system. The nurse specialist demonstrates the competency of implementation based on achievement of which outcome? Select all that apply. The update was implemented on the day it was to happen. The update was implemented within the budget developed for it. The update was implemented using the specified requirements of the plan. The update was implemented when the potential for problems would be minimal. The update was implemented beyond the scope of the original plan.

The update was implemented on the day it was to happen. The update was implemented within the budget developed for it. The update was implemented using the specified requirements of the plan. The competency of implementation is demonstrated when the informatics nurse specialist partners with the health care team to implement the plan on time, within budget and within the plan requirements. Implementing at a time when problems would be minimized and beyond the scope would not reflect this competency.

A nurse caring for a client at a health care facility has to maintain a medical record for the client. Which is a use of the medical record? To transmit health records between insurance companies. To investigate the quality of care in the agency. To inform family and others concerned about the client's care. To release the entire health record for research.

To investigate the quality of care in the agency. Medical records may occasionally be used to investigate the quality of care in the agency. A medical record is not used to transmit health records between insurance companies, to inform family and others concerned about the client's care, or to release the entire health record for research, as these actions would jeopardize the individual's right to privacy.

An informatics nurse specialist is engaged in evaluating a clinical information system. At which time would the nurse specialist anticipate the need to obtain help from a statistician? During the literature search When determining the data collection method When preparing how to display the data Just before documenting the outcome evaluation

When determining the data collection method It would be appropriate to secure the help of a statistician when the informatics nurse specialist is determining the data collection method and sample size. Securing help during the literature search would be too early. When preparing how to display the data or just prior to documenting the outcome evaluation would be too late. The nurse specialist would have had to analyze the data with the help of a statistician before displaying it.

A nurse working in a new orthopedic unit is asked to initiate the practice of an abbreviated form of documentation, which requires less nursing time and readily detects changes in client status. Which documentation method should the nurse suggest? charting by exception medication administration records problem, intervention, and evaluation note focus data, action, and response note

charting by exception The nurse should suggest the use of charting by exception, which is an abbreviated form of documentation. The FOCUS system of documentation organizes entries by data, action, and response. This system is broader in its view because a focus can be a problem area, but does not need to be. The problem, intervention, and evaluation note system simplifies documentation by incorporating the plan of care into the progress notes. The medication administration record documents only medication administration.

If a manual end-of-shift count of controlled substances isn't correct, the nurse's best action is to investigate and correct the discrepancy, if possible, before proceeding. immediately report the discrepancy to the nurse-manager, nursing supervisor, and pharmacy. document the discrepancy on an incident report. document the discrepancy on a opioid-inventory form

immediately report the discrepancy to the nurse-manager, nursing supervisor, and pharmacy. Reporting a noted discrepancy to the nurse-manager, nursing supervisor, and pharmacy should be the nurse's first step. Although the discrepancy may be easily corrected if investigated, the investigation isn't a nurse's responsibility. Documenting the discrepancy on an incident report or opioid-inventory form doesn't address the problem.

During a recent visit to the clinic, a client tells the nurse, "I've been using my cell phone to track and record the foods that I eat so that I can better understand if I'm making healthy food choices." The nurse interprets the client's statement as reflecting which technology? mHealth Telemedicine Patient portal Pharamcogenomics

mHealth The term "mHealth" is used to describe the rapidly evolving use of mobile technologies to track and improve health outcomes. Nurses, physicians, other care providers, and clients are using apps that enable quick and easy access to screens that provide information and can track progress. Telemedicine refers to the use of telecommunications technologies to support the delivery of all types of medical, diagnostic, and treatment-related services, usually by physicians or nurse practitioners. Examples include conducting diagnostic tests, monitoring a client's progress after treatment or therapy, and facilitating access to specialists that are not located in the same place as the client. Telemedicine involves only remote clinical services. Patient portals are a web-based tool that promote client engagement. Pharmacogenomics uses information about a person's genetic makeup, or genome, to choose the drugs and drug doses that are likely to work best for that particular person.

A group of nurses has established a focus group and pilot study to examine the potential application of personal data assistants (PDAs) in bedside care. This study is a tangible application of nursing informatics. electronic medical records. telemedicine. computerized documentation.

nursing informatics. Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. A specific application of nursing informatics is the use of PDAs in the clinical setting. The devices are less likely to be used to perform documentation or to constitute client records. Telemedicine involves the remote provision of care.

In many institutions, which telephone or fax orders requires a signature within 24 hours by the ordering physician or nurse practitioner? orders for antibiotics orders for diagnostic studies orders for dietary changes orders for respiratory treatments

orders for antibiotics Many institutional policies dictate that orders for restraints, narcotics, anticoagulants, and antibiotics require the ordering physician or nurse practitioner to sign the order within 24 hours.

Nurses who provide care in a large, long-term care facility use charting by exception (CBE) as the preferred method of documentation. This documentation method may have which drawbacks? vulnerability to legal liability because the nurse's safe, routine care is not recorded increased workload for nurses to complete necessary documentation failure to identify and record problems and associated interventions significant differences in charting among nurses from lack of standardization

vulnerability to legal liability because the nurse's safe, routine care is not recorded A significant drawback to charting by exception is its limited usefulness when trying to prove high-quality and safe care in response to a negligence claim made against nursing. CBE is generally less time-consuming than alternate methods of documentation and both standardization of charting and identification of client-specific problems are possible within this documentation framework.

Which measurements were most likely obtained from a normal newborn born at 38 weeks to a healthy mother term-33with no maternal complications? weight = 2000 g, length = 17 inches (43 cm), head circumference = 32 cm, and chest circumference = 30 weight = 2500 g, length = 18 inches (46 cm), head circumference = 32 cm, and chest circumference = 30 cm weight = 3500 g, length = 20 inches (51 cm), head circumference = 34 cm, and chest circumference = 32 cm weight = 4500 g, length = 22 inches (56 cm), head circumference = 36 cm, and chest circumference = 34 cterm-33m

weight = 3500 g, length = 20 inches (51 cm), head circumference = 34 cm, and chest circumference = 32 cm For a term infant, expected weight is 2500 to 4000 g; length is 19 to 21 inches (48 to 53 cm); head circumference is 33 to 35 cm; and chest circumference is 30.5 to 33 cm.


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