Question

a nurse is reviewing the documentation of a newly licensed nurse. which of the following entries should the nurse identify as meeting the american nurses association (ana) standards for documentation?
the client is now asleep, and they ate most of their breakfast a few hours ago.
the client vomited 240 ml of clear emesis but denies pain or nausea.
the client reports not feeling good, but they look fine.
the client has 8 to 10 sores on their body.

Explanation:

The ANA standards for documentation emphasize objectivity, accuracy, and specificity. The entry "The client vomited 240 mL of clear emesis but denies pain or nausea" provides specific quantitative (240 mL) and objective information about the client's condition. The other entries are either too vague ("The client is now asleep, and they ate most of their breakfast a few hours ago", "The client reports not feeling good, but they look fine", "The client has 8 to 10 sores on their body") as they lack precision or objectivity.

Answer:

"The client vomited 240 mL of clear emesis but denies pain or nausea."