A client states “I have something to tell you in confidence.” Which response by the nurse would be appropriate?
“I don’t want to know this. Tell your health care provider.”.
“I’m your nurse and you can tell me anything.”.
“I’ll close the door first so that no one will hear you.”.
“I can’t promise that the information won’t be shared if your health or safety is involved.”.
The Correct Answer is D
“I can’t promise that the information won’t be shared if your health or safety is involved.” This response by the nurse would be appropriate because it respects the client’s confidentiality while also acknowledging its limits of it. The nurse has a duty to report any information that may indicate a risk of harm to the client or others.
Choice A is wrong because it dismisses the client’s need to share something and implies that the nurse is not interested or trustworthy.
Choice B is wrong because it gives a false assurance of confidentiality and may lead to ethical dilemmas if the client reveals something that requires reporting.
Choice C is wrong because it does not address the issue of confidentiality and may give the impression that the nurse is trying to avoid the conversation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
These are natural respiratory defense mechanisms that help defend against infection.
Choice A is correct because cilia lining the respiratory tract sweep debris upward in mucus to be swallowed.
This prevents pathogens and particles from reaching the lungs.
Choice B is wrong because the respiratory tract does not cool and dry the air being inhaled. In fact, the respiratory tract warms and humidifies the air to facilitate gas exchange.
Choice C is correct because cells in the respiratory tract secrete lysozymes that can destroy certain bacteria.
Lysozymes are enzymes that break down the cell walls of bacteria.
Choice D is correct because macrophages engulf and destroy bacteria found in the alveoli. Macrophages are a type of white blood cell that act as scavengers of foreign invaders.
Choice E is wrong because high concentrations of oxygen and carbon dioxide do not aid the defense mechanisms.
On the contrary, high levels of these gases can impair gas exchange and cause acid-base imbalance.
Correct Answer is D
Explanation
I give the client his medications when the wife is grocery shopping. This statement would require the nurse to re-evaluate and correct the plan of care because home health aides are not allowed to administer medications in most states. Home health aides can only provide medication reminders, help put the medication into the hands of the user, or assist with self-administration of certain forms of medications.
Giving medications to the client without supervision or delegation by a registered nurse or physician is a violation of the scope of practice and could harm the client.
Choice A is wrong because removing throw rugs from the client’s walking path is a safety measure that can prevent falls and injuries for a client with Alzheimer’s disease.
Choice B is wrong because documenting activities with the client before leaving for the day is a professional responsibility that ensures continuity of care and accountability.
Choice C is wrong because contacting the nurse if there are any questions about the plan of care is a sign of good communication and collaboration that can enhance the quality of care for the client.
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