Nokea
A nurse is reinforcing teaching with a group of newly licensed nurses regarding client confidentiality. In which of the following situations can the nurse disclose health information without the client's written consent?
- A. To an employer for a pre-employment screening.
- B. To a family member when the client is not available.
- C. To a medical interpreter service on behalf of a client.
- D. To an insurance agency in regard to a life insurance policy.
Correct Answer: C
Rationale: Disclosure to an interpreter is permissible under HIPAA to facilitate care, ensuring accurate communication.
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A nurse is assisting in the care of a 72-year-old female client who recently had a stroke and is being monitored for complications. Complete the following sentence by using the lists of options. The client is at risk for developing ___ due to ___.
- A. Deep vein thrombosis (DVT)
- B. Prolonged immobility
- C. Urinary Catheter
- D. constipation
Correct Answer: A,B
Rationale: A: DVT is a risk post-stroke. B: Immobility increases clotting risk.
A nurse is assisting in the transfer of a client who has left-sided weakness from a bed to a chair. Which of the following actions should the nurse take?
- A. Flex hips and knees when assisting the client to a standing position.
- B. Pivot on the foot farthest from the bed when assisting the client into the chair.
- C. Stand on the client's stronger side when moving the client into the chair.
- D. Raise the bed to waist level before moving the client.
Correct Answer: A
Rationale: Flexing hips and knees uses proper mechanics, reducing injury risk during transfer.
A nurse in a provider's office is reviewing data from a client's medical record. Which of the following findings should the nurse identify as a risk factor for cardiovascular disease?
- A. Orthostatic hypotension.
- B. BMI of 24.
- C. Type 1 diabetes mellitus.
- D. Family history of osteoporosis.
Correct Answer: C
Rationale: Type 1 diabetes increases cardiovascular risk due to vascular damage.
A nurse is assisting a client in selecting an appropriate diet. Which of the following statements should the nurse make?
- A. Choose foods high in fiber and low in fat.
- B. Include a variety of fruits and vegetables.
- C. Drink plenty of water throughout the day.
- D. Limit the intake of sugary and processed foods.
Correct Answer: A
Rationale: High-fiber, low-fat foods support digestion and heart health.
A nurse is collecting data from a client who is 2 days postoperative following the placement of a colostomy. Which of the following findings should the nurse report to the provider?
- A. The stoma is draining a small amount of liquid stool.
- B. The stoma protrudes slightly from the abdomen.
- C. The stoma appears dark in color.
- D. The stoma bleeds lightly when touched.
Correct Answer: C
Rationale: A dark stoma suggests ischemia or necrosis, requiring urgent reporting.