A nurse on a medical-surgical unit receives a telephone call from an individual who identifies himself as the client's employer.
The employer asks the nurse about the client's condition.
Which of the following is an appropriate response by the nurse?
"The client's condition is stable right now.”.
"I will tell him you called.”.
"I cannot confirm or deny that we have a client by that name.”.
"He is here in the hospital, but I cannot tell you anything else.”. . .
The Correct Answer is C
Choice A rationale
Stating that the client's condition is stable right now is a breach of patient confidentiality and does not comply with privacy regulations.
Choice B rationale
Telling the employer that the nurse will inform the client about the call is also a breach of confidentiality, as it implies that the client is indeed there.
Choice C rationale
Responding with "I cannot confirm or deny that we have a client by that name" is an appropriate and professional way to protect patient confidentiality and comply with privacy laws.
Choice D rationale
Stating that the client is in the hospital but not providing further details still reveals the client's location, which breaches patient confidentiality and privacy regulations. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D","E"]
Explanation
Choice A rationale
Padding bony prominences helps prevent skin breakdown and pressure ulcers, which are critical considerations when using restraints to avoid additional complications for the client.
Choice B rationale
Tying restraints to the bed rail is unsafe because it can lead to injury if the bed rail is moved. Restraints should be tied to the bed frame to prevent accidental harm.
Choice C rationale
Using a square knot for restraints is inappropriate as it is difficult to untie quickly in an emergency. Quick-release knots are recommended for safety and efficiency.
Choice D rationale
Observing the client's skin integrity every 2 hours is essential to detect early signs of skin breakdown and take preventive actions to ensure the client's comfort and safety.
Choice E rationale
Ensuring that two fingers can fit between the restraint and the client ensures that the restraint is not too tight, allowing for circulation and reducing the risk of injury.
Correct Answer is A
Explanation
Choice A rationale
Securing the catheter helps prevent it from moving, which reduces the risk of urethral trauma and infection. Proper fixation is essential for patient safety and comfort.
Choice B rationale
Urine should not be obtained from the drainage bag for specimen collection as it may be contaminated. Fresh urine samples directly from the catheter port are more accurate.
Choice C rationale
Catheter bags should be changed based on clinical need, which can be more frequent than every 3 days. This ensures hygiene and reduces infection risks.
Choice D rationale
The drainage bag should be kept below the bladder level to prevent backflow of urine, which can lead to infection.
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