# Situation: A 34-year-old man with a closed fracture of the left femur is in skeletal traction on the orthopedic ward, 1 day after admission. The ward keeps a Kardex for each client and writes its nursing notes on paper. A nursing student asks why the nurse still writes notes in the chart when the Kardex already lists the client's orders and planned care. Which statement about the Kardex explains this?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630457  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 34-year-old man with a closed fracture of the left femur is in skeletal traction on the orthopedic ward, 1 day after admission. The ward keeps a Kardex for each client and writes its nursing notes on paper.

A nursing student asks why the nurse still writes notes in the chart when the Kardex already lists the client's orders and planned care. Which statement about the Kardex explains this?

## 보기

1. It is a working summary, revised or discarded as orders change **✔ 정답**
2. It records only the medicines, not treatments or activity
3. It is an internal quality document, like an incident report
4. It is a legal record, but only for the physician's orders it lists

**정답: 1**

## 해설

The Kardex is a summary card or screen of current diagnosis, orders, medications, activity, precautions, and allergies, used for planning and handoff. Because it is updated as orders change and usually is not kept as part of the permanent record, care given and client responses must be documented in the chart.

## 심화 해설

What the Kardex is
The Kardex is a summary card, folder, or screen that lists a client's current diagnosis, active orders, medications, treatments, activity, precautions, and allergies. Nurses use it for planning the shift's care and for endorsement at handoff. Because the Kardex is a working summary that is revised or discarded as orders change and usually is not kept as part of the permanent record, the care given and the client's responses must be documented in the chart. This answers the student's question.

Kardex versus the chart
The client's chart (medical record) is the permanent legal document of care. It contains the physician's order sheet, nursing notes, flow sheets, and medication administration records. The Kardex only summarizes what is in the chart. Entries on it are often written in pencil or updated electronically as orders change, and old cards may be discarded at discharge. Anything recorded only on the Kardex may therefore be lost, and it would not show what was actually done or how the client responded.

| Feature | Kardex | Chart (medical record) |
| --- | --- | --- |
| Purpose | Quick reference for planning and handoff | Permanent legal record of care |
| Content | Summary of current orders, care, precautions | Orders, notes, assessments, care given, responses |
| Updated | Revised as orders change | Entries added, never erased |
| Retention | Often discarded | Kept permanently |

Why the other options are wrong
The Kardex lists far more than medicines: it includes diagnosis, treatments, activity, precautions, and allergies. It is a care-planning tool, not an internal quality or risk document such as an incident report. And it is not the legal record for physician's orders; the legal source of orders is the order sheet in the chart, which the Kardex only summarizes.

Watch out! A complete Kardex can feel like enough documentation, but planned care is not the same as care delivered. Only the chart proves what was done.

Exam takeaway
Key point! The Kardex is a temporary working summary for planning and endorsement; care given and client responses are documented in the permanent chart.

## 임상 시나리오

Kardex and the ChartWhy nurses still write notes
The Kardex summarizes current diagnosis, orders, medications, activity, precautions, and allergies for planning and endorsement.

It is revised or discarded as orders change and usually is not part of the permanent record.

The chart is the legal record: orders, nursing notes, care given, and client responses must be written there.

CautionDo not document care only on the Kardex; information there may be lost and does not prove what was done.

## 핵심 개념

- **Kardex** — A summary card or screen of current orders and planned care used for planning and handoff.
- **Endorsement** — The handoff report in which responsibility for clients passes from one nurse to the next.
- **Medical record** — The permanent legal document of a client's care, including orders, notes, and results.
- **Order sheet** — The part of the chart where physicians write orders; it is the legal source of those orders.

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