Illinois Nursing Home Administrators (NHA) Practice Exam

What is expected of the nurse regarding dose administration records?

1. Maintain complete confidentiality

2. Regularly update training on medication laws

3. Document every medication given accurately

4. Review medication lists with residents

The correct answer is: Document every medication given accurately

The expectation for the nurse regarding dose administration records is to document every medication given accurately. Accurate documentation is critical in nursing practice; it ensures that there is a clear and precise account of the medications administered to residents. This accuracy is vital for several reasons: it supports the continuity of care by providing other healthcare providers with the exact medications a resident has received, it helps to avoid potential medication errors, and it is a legal requirement that can affect liability and compliance with healthcare regulations. The importance of thorough documentation cannot be overstated, as it directly impacts patient safety and quality of care. Ensuring that records reflect the proper medication, dosage, route, and time of administration contributes to a comprehensive healthcare record, which is essential for both clinical decision-making and regulatory compliance. While maintaining complete confidentiality, regularly updating training on medication laws, and reviewing medication lists with residents are all important responsibilities within nursing practice, they do not specifically address the direct and immediate need for accurate documentation of medications given, which is crucial in ensuring the safety and well-being of residents in a nursing home setting.