Nokea
A nurse overhears two assistive personnel (AP) in the nurses' station discussing a client who was recently admitted. Which of the following actions should the nurse take?
- A. Tell the APs to stop the conversation.
- B. Document the event in the client's progress notes.
- C. Inform the client of the APs' actions.
- D. Submit an incident report to the risk manager.
Correct Answer: A
Rationale: Telling the APs to stop the conversation is correct. Discussing client information in a public area violates HIPAA (Health Insurance Portability and Accountability Act) privacy regulations. The nurse should immediately intervene and remind the APs about maintaining client confidentiality.
You may also like to solve these questions
A nurse is caring for a client who has a new diagnosis of osteoporosis. Which of the following dietary recommendations should the nurse make?
- A. Increase calcium intake.
- B. Limit protein intake.
- C. Avoid whole grains.
- D. Reduce vitamin D intake.
Correct Answer: A
Rationale: Increasing calcium intake supports bone health and helps prevent further bone loss in osteoporosis.
A nurse is caring for a client who has a new prescription for prednisone. Which of the following adverse effects should the nurse monitor for?
- A. Hypoglycemia
- B. Weight loss
- C. Bradycardia
- D. Insomnia
Correct Answer: D
Rationale: Prednisone, a corticosteroid, can cause insomnia due to its stimulatory effect on the central nervous system.
A nurse is caring for a client who has a new diagnosis of trigeminal neuralgia. Which of the following findings should the nurse expect?
- A. Facial pain
- B. Weight gain
- C. Bradycardia
- D. Hypotension
Correct Answer: A
Rationale: Facial pain, often severe and shock-like, is a hallmark symptom of trigeminal neuralgia affecting the trigeminal nerve.
A nurse is reinforcing teaching with a client who has a new prescription for a progesterone injection. Which of the following instructions should the nurse include?
- A. Inject into the thigh.
- B. Rotate injection sites.
- C. Store the medication in the refrigerator.
- D. Massage the site after injection.
Correct Answer: B
Rationale: Rotating injection sites for progesterone injections prevents tissue irritation and ensures consistent absorption.
A nurse is providing preoperative care to a client who reports he has no one at home to help him after his outpatient surgery. Which of the following actions should the nurse take?
- A. Assist with a referral to a home health care agency.
- B. Call the provider about admitting the client to the facility overnight.
- C. Give the client a list of home care assistants to contact.
- D. Contact the next of kin to assist the client at home.
Correct Answer: A
Rationale: Assist with a referral to a home health care agency is correct. If the client has no one to assist them at home after surgery, a home health care agency can provide the necessary support. This is a proactive solution to ensure the client has assistance for postoperative recovery, including monitoring for complications, assistance with mobility, and other care needs.