A nurse is speaking with a visitor who asks a question about the status of a relative who is a client on the unit. Which of the following responses by the nurse is appropriate?

"Please ask your relative about this, because I cannot share information about her."

"I'm not taking care of your relative today, so I don't have the latest information."

"I will have your relative's nurse come and talk with you about her care."

"Let me check your relative's medical record to see how she's doing."

Answer and Explanation

The Correct Answer is C

Choice A reason: This response is inappropriate because it violates the client's right to privacy and confidentiality. The nurse should not disclose any information about the client to anyone without the client's consent, unless it is required by law or for the client's safety.

Choice B reason: This response is inappropriate because it shows a lack of accountability and professionalism. The nurse should not dismiss the visitor's concern or pass the responsibility to another nurse. The nurse should either provide the information if they have it or direct the visitor to the appropriate source.

Choice C reason: This response is appropriate because it respects the client's privacy and confidentiality, while also addressing the visitor's concern. The nurse should inform the visitor that they will contact the nurse who is taking care of the client and ask them to come and talk with the visitor.

Choice D reason: This response is inappropriate because it violates the client's privacy and confidentiality. The nurse should not access the client's medical record without a valid reason or the client's consent. The nurse should only check the medical record if they are involved in the client's care or have a need to know the information.

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Correct Answer is A

Explanation

Choice A reason: This is the correct choice because this information is relevant and important for the physical therapist. A hemoglobin of 5 g/dL indicates severe anemia, which can cause fatigue, weakness, shortness of breath, and palpitations. The physical therapist should be aware of the client's condition and adjust the therapy accordingly. The physical therapist should also monitor the client's vital signs, oxygen saturation, and tolerance to activity.

Choice B reason: This is not the correct choice because this information is not relevant or important for the physical therapist. A clean-catch urine test is a diagnostic test that requires the client to collect a midstream urine sample in a sterile container. The physical therapist does not need to know about this test or its results, as it does not affect the client's physical therapy.

Choice C reason: This is not the correct choice because this information is not relevant or important for the physical therapist. Opioid-induced constipation is a side effect of opioid medications that can cause abdominal pain, bloating, and difficulty passing stools. The physical therapist does not need to know about this condition or its treatment, as it does not affect the client's physical therapy.

Choice D reason: This is not the correct choice because this information is not relevant or important for the physical therapist. A new diagnosis of colorectal cancer is a serious and life-changing condition that requires medical and surgical interventions. The physical therapist does not need to know about this diagnosis or its prognosis, as it does not affect the client's physical therapy.

A. A nurse places a mask on a client with tuberculosis before transport to the radiology department. B. A nurse cleans up a blood spill with hydrogen peroxide. C. A nurse removes her gown after leaving the client's room. D. A nurse disconnects an indwelling urinary catheter from the drainage bag to collect a specimen.

Correct Answer is A

Explanation

Choice A reason: A nurse places a mask on a client with tuberculosis before transport to the radiology department is a safe handling technique, as it prevents the transmission of airborne pathogens to other clients and staff. The nurse should also wear a respirator and follow the standard and airborne precautions.

Choice B reason: A nurse cleans up a blood spill with hydrogen peroxide is not a safe handling technique, as it can damage the skin and mucous membranes and cause irritation and infection. The nurse should use a bleach solution or an approved disinfectant to clean up blood spills and follow the standard and contact precautions.

Choice C reason: A nurse removes her gown after leaving the client's room is not a safe handling technique, as it can contaminate the environment and expose the nurse to infectious agents. The nurse should remove the gown before leaving the client's room and dispose of it in a designated receptacle.

Choice D reason: A nurse disconnects an indwelling urinary catheter from the drainage bag to collect a specimen is not a safe handling technique, as it can introduce bacteria into the urinary tract and cause infection. The nurse should use a sterile syringe and needle to aspirate the specimen from the sampling port and follow the standard and contact precautions.

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A nurse is speaking with a visitor who asks a question about the status of a relative who is a client on the unit. Which of the following responses by the nurse is appropriate?

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