Which Entry Should the Nurse Include When Charting? Select All

Multiple Choice

Which entry should the nurse include when charting? Select all that apply.

A) The nursing assistant reports the client's breath smelled of alcohol.
B) I feel something is going on he or she is not telling me.
C) The client was overheard telling his or her family about more bleeding than he or she has reported to his or her physician.
D) The incision is oozing a small amount of red blood.
E) The client's pupils are dilated.