Management of Care Practice Question

Question

The nurse is caring for a family requesting information and is focused on legal documentation scenario 2. Which nursing action is most appropriate?

Answer choices

1. A. Delay assessment until the next scheduled round if the client is not calling for help.
2. B. Delegate the clinical assessment and nursing judgment to assistive personnel.
3. C. Chart timely, objective, factual assessments and interventions.
4. D. Document the concern without notifying the appropriate provider or care team member when escalation is needed.

Correct Answer

C. Chart timely, objective, factual assessments and interventions.

Explanation

The priority action for legal documentation is to chart timely, objective, factual assessments and interventions. NCLEX-style prioritization favors safety, assessment, appropriate delegation, timely escalation, and client-centered teaching.

Question details

• Difficulty: medium
• Domain: Management of Care
• Objective: legal documentation

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