A nurse is reinforcing teaching about advance directives with a client who has end-stage heart failure.

Which of the following statements by the client indicates an understanding of the teaching?

Giving change-of-shift report to a nurse outside the client's room helps to maintain client confidentiality. By discussing sensitive client information in a private and secure area, such as a designated report room or a location where other clients or visitors cannot overhear, the nurse ensures that the client's personal and medical information is not disclosed to unauthorized individuals.

Writing a client's diagnosis on the message board in the client's room can potentially expose sensitive medical information to anyone who enters the room, including visitors or other healthcare providers who are not directly involved in the client's care.

Discussing a client's prognosis with an assistive personnel who is caring for the client may violate the principle of need-to-know confidentiality. While it is important for healthcare team members to collaborate and communicate about client care, sensitive information should only be shared on a need-to-know basis.

Discarding worksheets containing client information in a wastebasket without proper shredding or disposal methods can potentially expose client information to unauthorized individuals who may come across the discarded documents. Proper procedures for document disposal, such as shredding or using secure disposal containers, should be followed to protect client confidentiality.

This situation involves a medication error that could potentially harm the client, and it should be reported through an incident report.

The following examples may not require an incident report:

A nurse discovers that a client's family member has administered a PCA dose. PCA (Patient-Controlled Analgesia) is a method of pain management that allows the client to self-administer pain medication within predetermined limits. If a family member administers the PCA dose without proper authorization or understanding, it is a safety concern that should be reported.

A nurse observes a client vomiting after receiving an oral pain medication. While this situation should be assessed and managed appropriately, it does not necessarily warrant an incident report unless there are additional factors or complications involved.

A nurse observes another nurse remove wrist restraints one at a time from a client who is currently calm. This situation may raise concerns regarding proper restraint removal techniques or potential safety issues, but it does not inherently indicate an immediate need for an incident report. However, if the nurse's actions were contrary to policy or posed a risk to the client's safety, it should be reported.