A nurse is reviewing client confidentiality with other staff members.
The nurse should identify that which of the following actions is an example of protecting client confidentiality?

Writing a client's diagnosis on the message board in the client's room.

Discarding worksheets containing client information in a wastebasket.

Giving change-of-shift report to a nurse outside the client's room.

Discussing a client's prognosis with an assistive personnel who is caring for the client.

Answer and Explanation

The Correct Answer is C

Choice A rationale: Writing a client's diagnosis on the message board in the client's room can expose sensitive information to anyone who enters the room, which compromises client confidentiality.

Choice B rationale: Discarding worksheets containing client information in a wastebasket is not secure and can lead to unauthorized access to confidential information.

Choice C rationale: Giving change-of-shift report to a nurse outside the client's room protects client confidentiality by ensuring that sensitive information is shared only with authorized personnel in a private setting.

Choice D rationale: While sharing relevant information with personnel directly involved in the client's care is generally acceptable, it must still be done in a manner that safeguards confidentiality.

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Correct Answer is A

Explanation

Choice A rationale:

Supplement spoken language with pictures. Rationale: When caring for a client who speaks a different language, supplementing spoken language with pictures or visual aids is a helpful communication strategy. Visual aids can assist in conveying important information, instructions, and concepts effectively, especially when there is a language barrier.

Choice B rationale:

Ask a family member of the client to interpret. Rationale: Relying on a family member to interpret can be problematic, as it may compromise the privacy and confidentiality of the client's healthcare information. Additionally, family members may not always be available or proficient in the required language, making it an unreliable method of communication.

Choice C rationale:

Recognize that the client nodding indicates an understanding of the information. Rationale: Assuming that nodding indicates understanding is not a reliable approach, as nodding can have different cultural interpretations and may not necessarily indicate comprehension. It is important to use clear and simple language, along with visual aids when necessary, to ensure effective communication.

Choice D rationale:

Speak to the client at an increased volume. Rationale: Speaking at an increased volume is not an appropriate approach to communication with a client who speaks a different language. It can be perceived as rude or aggressive and is unlikely to improve understanding. Clear and concise communication, along with visual aids or interpretation services when needed, is a more effective strategy.

A. Evaluate the client for signs of infection. B. Check the fetal heart rate pattern. C. Observe the color and consistency of amniotic fluid. D. Take the client's temperature.

Correct Answer is B

Explanation

Choice A rationale:

Evaluating the client for signs of infection is an important nursing action in post-procedure care, but it is not the priority immediately following an amniotomy. The primary concern after an amniotomy is fetal well-being, so monitoring the fetal heart rate is the priority.

Choice B rationale:

Checking the fetal heart rate pattern is the priority nursing action following an amniotomy. Amniotomy involves breaking the amniotic sac, which can potentially lead to changes in the fetal heart rate. Monitoring the fetal heart rate helps assess the baby's well-being and detects any signs of fetal distress.

Choice C rationale:

Observing the color and consistency of amniotic fluid is important for assessing the fluid for signs of meconium staining or infection, but it is not the immediate priority after an amniotomy. Checking the fetal heart rate takes precedence.

Choice D rationale:

Taking the client's temperature is an important part of assessing for infection or fever, but it is not the immediate priority following an amniotomy. Fetal well-being and monitoring are the primary concerns in the immediate post-amniotomy period.

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A nurse is reviewing client confidentiality with other staff members. The nurse should identify that which of the following actions is an example of protecting client confidentiality?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who speaks a different language than the nurse.Which of the following actions should the nurse take?

Correct Answer is A

Explanation

A nurse is assisting in the care of a client who is to undergo an amniotomy.Which of the following is the priority nursing action following this procedure?

Correct Answer is B

Explanation

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A nurse is reviewing client confidentiality with other staff members.
The nurse should identify that which of the following actions is an example of protecting client confidentiality?