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Which documentation entry by the nurse is best?

A newly licensed nurse asks what should be included in the client’s medical record after a fall. Which response by the charge nurse is correct?

A postoperative client reports pain of 6/10 before ambulating to the bathroom. Which action by the nurse is most appropriate?

A nurse is preparing to provide education to a client who is deaf and uses American Sign Language (ASL). Which action is required by the hospital to ensure effective communication?

Please fill Skill 4 form for Phil 4:4-9. Make sure to complete ALL components of the exercise as described in the instructions on the form. 

A postoperative client reports incisional pain of 5/10 and states, “I don’t want more pain medicine right now if I can avoid it.” Which action should the nurse take?

A nurse remembers at 1400 that a sterile dressing change was completed at 1200 but was not documented. Which action should the nurse take?

A nurse is completing a preoperative checklist for a client scheduled for surgery. Which finding should the nurse report to the provider before the client is transported to the operating room?

A nurse is caring for a client in a high-acuity unit where multiple monitors are alarming, several staff members are speaking at once, and the overhead lights are brightly lit. The client reports feeling overwhelmed and is becoming increasingly agitated. The nurse should recognize these findings as:

A nurse is caring for a postoperative client who received IV hydromorphone 20 minutes ago. Which assessment finding requires the most immediate intervention?