A nurse in a provider's office receives a telephone call from a client's sibling requesting current information about the client's condition. Which of the following actions should the nurse take?

Gather additional information from the caller to verify their identity.

Request that the caller contact the client's provider directly for information.

Ask the caller to contact the client directly for information.

Provide the caller with a brief update about the client's condition.

Answer and Explanation

The Correct Answer is C

A. Gather additional information from the caller to verify their identity: Even if the caller's identity is verified, HIPAA regulations prohibit disclosing a client's medical information without the client’s explicit authorization. Verifying identity alone does not grant permission to release confidential health information.

B. Request that the caller contact the client's provider directly for information: Redirecting the caller to the provider does not resolve the issue of confidentiality. Healthcare providers are also bound by HIPAA regulations and cannot release information without proper consent, regardless of who is making the request.

C. Ask the caller to contact the client directly for information: This action respects the client’s privacy and autonomy. Under HIPAA, healthcare professionals may not disclose health information without client authorization. Advising the sibling to speak directly with the client is the appropriate response to safeguard confidentiality.

D. Provide the caller with a brief update about the client's condition: Sharing any health information without the client’s express consent is a violation of HIPAA. Even a brief update constitutes a breach of confidentiality and could result in legal and professional consequences.

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Correct Answer is C

Explanation

A. Headache: Headache can occur during a transfusion reaction but is usually a less urgent symptom. It should be monitored but is not the highest priority.

B. Urticaria: Urticaria (hives) often indicates a mild allergic reaction to the transfusion. It requires intervention but is generally not immediately life-threatening.

C. Dyspnea: Dyspnea signals possible respiratory distress, which may indicate a severe transfusion reaction such as anaphylaxis or transfusion-related acute lung injury (TRALI). This requires immediate attention and reporting to prevent respiratory failure.

D. Hyperthermia: A fever during transfusion suggests a febrile non-hemolytic reaction or infection risk, which is important but typically not as urgent as respiratory distress.

A. Administer an antibiotic. B. Limit foods high in potassium. C. Limit alcohol intake to 2 drinks per day. D. Administer a diuretic. E. Keep daily fat intake to less than 35%. F. Place on 2,300 mg sodium diet.

Correct Answer is ["B","D","E","F"]

Explanation

A. Administer an antibiotic: There is no indication of infection; WBC count is normal, and the client is afebrile. The reported symptoms relate to lifestyle and substance use rather than a bacterial illness, making antibiotics unnecessary.

B. Limit alcohol intake to 2 drinks per day: The client uses 4–5 beers nightly to sleep, indicating alcohol misuse that can exacerbate hypertension and negatively impact sleep quality. Limiting intake supports cardiovascular and liver health, and aligns with public health recommendations.

C. Limit foods high in potassium: The client’s potassium level is within the normal range (3.7 mEq/L), and there is no evidence of kidney dysfunction or hyperkalemia. Restricting potassium is unwarranted and could risk deficiency.

D. Administer a diuretic: The client has elevated blood pressure (162/90 mm Hg), which may require pharmacologic intervention. Diuretics are a common first-line treatment for hypertension as they reduce fluid overload and vascular resistance.

E. Keep daily fat intake to less than 35%: The client’s LDL (210 mg/dL) and total cholesterol (248 mg/dL) levels are significantly elevated. Reducing total fat intake, particularly saturated fats, is essential for lowering cholesterol and reducing cardiovascular risk.

F. Place on 2,300 mg sodium diet: A sodium-restricted diet is standard for managing hypertension. The American Heart Association recommends limiting sodium to help control blood pressure and reduce cardiovascular complications.

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A nurse in a provider's office receives a telephone call from a client's sibling requesting current information about the client's condition. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is ["B","D","E","F"]

Explanation

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