Exam 74: Documentation and Informatics

A nurse in a long-term care setting that is funded by Medicare and Medicaid is completing standardized protocols for assessment and care planning and for meeting quality improvement within and across facilities.Which task did the nurse just complete?

A nurse has taught the staff about informatics.Which statement indicates that the staff needs more education?

A nurse is teaching the staff about health care reimbursement.Which information should the nurse include?

A nurse is discussing the advantages of standardized documentation forms in the nursing information system.Which advantage should the nurse describe?

A nurse prepared an audiotaped exchange with another nurse of information about a patient.Which action did the nurse complete? The nurse completed a

Which entry will require follow-up by the nurse manager?

A nurse is charting on a patient's record.Which action is most accurate legally?

A patient is being discharged home.Which information should the nurse include?

A preceptor is working with a new nurse on documentation.Which situation will cause the preceptor to intervene?

A nurse has provided care to a patient.Which entry should the nurse document in the patient's record?

A nurse wants to reduce data entry errors on the computer system.Which behavior should the nurse implement?