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A nurse manager observes an unknown man in a laboratory coat making copies of a client's medical record. Which of the following actions should the nurse plan to take first?

Report the observation to the nurse caring for that client.

Inform the nursing supervisor.

Approach the man and ask why he is making copies.

Notify hospital security.

Answer and Explanation

The Correct Answer is C

Rationale:

A. Reporting the observation to the nurse caring for that client is important but not the immediate priority.

B. Informing the nursing supervisor is necessary but should be done after assessing the situation directly.

C. Approaching the man and asking why he is making copies is the most immediate and direct action. It allows the nurse to assess the situation and determine if the man has legitimate access to the client's medical record or if further action is needed.

D. Notifying hospital security may be necessary if the man’s actions are unauthorized, but the first step is to gather more information.

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Correct Answer is D

Explanation

Rationale:

A. Lean gently over the back of a chair sitting to one side of the room may appear disengaged or unprofessional.

B. Cross her arms over her chest is a closed posture that may seem defensive or unapproachable.

C. Stare at the people the announcement will affect the most can be intimidating or uncomfortable for others.

D. Sit in front of the group for the meeting and then stand for the announcement is effective for emphasizing the importance of the announcement and engaging the audience.

A. "The client works in the hospital radiology department." B. "The client discussed having prior thoughts of suicide." C. "The client's blood pressure and pulse have been fluctuating throughout the day." D. "The client's family members have been present most of the day."

Correct Answer is C

Explanation

A. "The client works in the hospital radiology department": This information is irrelevant to the client’s current health status and does not imply a need for total care by the nurse.

B. "The client discussed having prior thoughts of suicide": While suicidal ideation is serious and requires careful monitoring and assessment, this information alone does not necessarily indicate that the nurse must assume total care. A nurse would still delegate non-critical tasks to the AP, but constant monitoring and appropriate interventions would still be the nurse’s responsibility.

C. "The client's blood pressure and pulse have been fluctuating throughout the day": Fluctuating vital signs, especially blood pressure and pulse, can indicate an unstable condition that may require immediate attention and careful monitoring. This scenario suggests that the client’s condition may be critical and requires ongoing assessment and evaluation by the nurse, rather than simply delegating tasks like monitoring vital signs to assistive personnel (AP). The nurse needs to assess the situation thoroughly, interpret the fluctuations, and adjust the care plan accordingly.

D. "The client's family members have been present most of the day": Family presence alone does not impact the need for total care by the nurse. It is important for the nurse to communicate with the family, but this statement does not indicate the need for the nurse to assume total care over other team members.

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A nurse manager observes an unknown man in a laboratory coat making copies of a client's medical record. Which of the following actions should the nurse plan to take first?

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Naxlex Comprehensive Predictor Exams

A nurse who is leading a team of nurse managers is planning to make a major announcement. The nurse should use which of the following nonverbal communication techniques to enhance the importance of the announcement?

Correct Answer is D

Explanation

A nurse is receiving change-of-shift report at the start of the shift. Which of the following statements by the nurse giving report indicates to the oncoming nurse that she should assume total care for the client, rather than assigning tasks to the assistive personnel (AP)?

Correct Answer is C

Explanation

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