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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 B

Explanation

Rationale:

A. Measuring I&O can be performed by an AP, as it does not require advanced skills or clinical judgment.

B. Reinforcing teaching about medication is within the LPN's scope of practice, as LPNs are trained to provide education and support based on the teaching provided by RNs or physicians.

C. Developing a plan of care is generally a responsibility of the RN, as it involves comprehensive assessment and planning.

D. Completing an admission assessment is a task for RNs due to its complexity and the need for a detailed clinical evaluation.

A. Verify the AP's educational preparation prior to delegating the task. B. Observe the AP as she obtains the vital signs of each client. C. Determine the time frame the AP should report the results D. Ask the AP to take the vital signs of the client returning from surgery first.

Correct Answer is C

Explanation

Rationale:

A. Verify the AP's educational preparation prior to delegating the task is unnecessary if the AP has been trained and is competent in the task.

B. Observe the AP as she obtains the vital signs of each client is not required for routine tasks unless there is a concern about performance.

C. Determine the time frame the AP should report the results is crucial for ensuring timely and accurate reporting, which is necessary for effective patient care.

D. Ask the AP to take the vital signs of the client returning from surgery first might not be appropriate without considering the urgency of all clients’ conditions.

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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?

Nursing Test Bank

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