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5 Written questions

5 Matching questions

  1. prescription pad
  2. nursing care plan
  3. long-term care unit dose system
  4. individual prescription order system
  5. Special documentation circumstances
  1. a prescriptions for patient's leaving hospital; presc given at clinics, outpatient surgeyr; additional info may be written "take with meals"; duration; pharmacies require patient's age and address on the presc
  2. b is an adaptation of the system used in the acute care setting. This is designed with ind drawers to hold one resident's med containers for 1 week. Drawer is labeled with the resident's name, room #, pharmacy name and telephone number and name of the health care facility.
  3. c pt refuses med (thoroughly record incident and reason for refusal in nurses notes; notify dr; med error occurs
  4. d after initial data collection, this is done and this incorporates nursing diagnoses, critical pathway info, and physician-ordered and nursing-ordered care.
  5. e meds are dispensed from the pharmacy upon receipt of a prescription or drug order for an ind patient. Pharmacy sends supply of med ina bottle or box for patient, may hold 3-5 day supply. Meds are stored in med cabinet at nurse's station, med is removed as needed. ADVANTAGES: Review of prescription by nurse and pharmacist so greater patient safety; less chance for deterioration or expiration; easier inventory control; less chance for misuse by others; easier to charge patient; med is available for stat or prn usage. DISADVANTAGES: Frequent need to return or discard unused meds; complex ordering, preparing, administering, controlling, and recording systems required-time consuming

5 Multiple choice questions

  1. summary sheet; consent forms; physician's order form; H&P form; progress notes; critical pathways; nurses notes; lab tests record; graphic record; flow sheets; consultation reports; other diagnostic reports; MAR: PRN or unscheduled med record; case management; patient education record
  2. nurses record ongoing assessments of the patient's condition; responses to nursing interventions ordered by the physician or those initiated by the nurse; evaluations of the effectiveness of nursing interventions; procedures completed by other health professionals and other pertinent info such as physician or family visits and the patient's responses after these visits.
  3. Right patient, drug, time, dose, route and documentation
  4. althought the physician may order the correct dosage of the med, changes in the pt's status may require that the dosage be altered; the nurse must use the proper equipment, the proper drug form and the proper concentration; calculations must be right; check usual drug dosage
  5. depends on severity of effects on the pt; if due to carelessness or negligence of the nurse, the nurse may be held legally liable; repeated errors cannot be ignored

5 True/False questions

  1. The right documentationnotation on chart should be made ASAP after administering; parenteral; MAR; progress notes. CAUTION: Never record meds that you did not give or record meds before they are given; never give med prepared by another nurse; you cannot assume that all of the rights were followed unless you do it yourself

          

  2. floor or ward stock systemfloor or ward stock system, ind presc. order system, unit dose system, automated dispensing system

          

  3. progress notesphysician records frequent observations of the patient's health status on this

          

  4. transcriptionprescriptions for patient's leaving hospital; presc given at clinics, outpatient surgeyr; additional info may be written "take with meals"; duration; pharmacies require patient's age and address on the presc

          

  5. laboratory tests recordis an example of manual recording of temp, pulse, resp and bp. Pain assessment nka the 5th vital sign can also be recorded on this.

          

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