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Which of the following are violations of the Health Insurance Portability and Accountability Act regarding confidentiality of privileged health information? Select all that apply.
- A. A pregnancy result is given to a husband without the wife's permission
- B. The client overhears, through a privacy curtain, the nurse call report on someone
- C. The nurse calls the client by first and last name in the public waiting room
- D. The nurse tells the transporting tech that the client has breast cancer
- E. Unlicensed assistive personnel tell the discharged client, 'You take care now.'
Correct Answer: A,C,D
Rationale: Sharing pregnancy results without consent (A), calling names publicly (C), and disclosing a diagnosis to non-care staff (D) violate HIPAA. Overhearing through a curtain (B) is unintentional, and a general farewell (E) is not a violation.
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A client with coronary artery disease is being seen in the clinic for a follow-up examination. During medication reconciliation, the nurse identifies which reported medication as requiring further investigation?
- A. 10 mg isosorbide dinitrate twice daily
- B. 20 mg atorvastatin once daily
- C. 500 mg naproxen twice daily
- D. 2,000 mg fish oil once daily
Correct Answer: C
Rationale: Naproxen (C), an NSAID, increases cardiovascular risk and bleeding, requiring investigation in coronary artery disease. Isosorbide (A), atorvastatin (B), and fish oil (D) are appropriate.
The nurse is with a client with obsessive-compulsive disorder who counts backwards several times each day. Which of the following statements by the client would indicate an improvement in the client's condition? Select all that apply.
- A. I take a short, brisk walk to decompress when I begin to feel anxious.
- B. My neighbor goes grocery shopping for me because I get anxious and begin counting.
- C. Having a stressful job worsens my anxiety, but I use deep-breathing exercises to manage it.
- D. Counting helps me cope with my anxiety. It does not hurt anyone, and it is better than drinking alcohol.
- E. I used to start counting as soon as I boarded the bus, but now I can ride the bus for 30 minutes without counting.
Correct Answer: A,C,E
Rationale: Statements A, C, and E indicate improvement as the client uses adaptive coping strategies (walking, deep breathing) and reports reduced compulsive behavior (delayed counting). Statement B shows reliance on others, and D justifies the compulsion, both indicating no improvement.
The nurse is caring for a client with increased intracranial pressure (ICP). Which statement by the unlicensed assistive personnel would require immediate intervention by the nurse?
- A. I will raise the head of the bed so it is easier to see the television.
- B. I will turn down the lights when I leave.
- C. Let me move your belongings closer so you can reach them
- D. You should do deep breathing and coughing exercises.
Correct Answer: A
Rationale: Raising the head of the bed (A) without medical guidance can alter ICP dangerously. Dimming lights (B), moving belongings (C), and breathing exercises (D) are generally safe or neutral.
A charge nurse working in a long term care facility is making out assignments. Which assignment made by a registered nurse to an unlicensed assistive personnel (UAP) requires intervention by the supervisor?
- A. Provide decubitus ulcer care and apply a dry dressing
- B. Bathe and feed a client on bed rest
- C. Oral suctioning of an unresponsive elderly client
- D. Teaching a family intermittent (bolus) feedings via G-tube before discharge
Correct Answer: D
Rationale: Teaching a family intermittent (bolus) feedings via G-tube before discharge. Initial teaching cannot be delegated to a UAP or a PN and must be done by RNs.
The nurse is assessing a 7-year-old client who was recently admitted with nausea, vomiting, severe right lower quadrant pain, and an elevated WBC count. Which of the following statements by the client would be a priority to follow up?
- A. I feel so tired.
- B. I am hungry and I want to eat.
- C. My stomach does not hurt anymore.
- D. I do not like hospitals and I want to go home.
Correct Answer: C
Rationale: Resolution of pain (C) in suspected appendicitis may indicate perforation, a surgical emergency, requiring urgent follow-up. Fatigue (A), hunger (B), and dislike of hospitals (D) are less critical.