A nurse overhears two assistive personnel (AP) in the nurses' station discussing a client who was recently admitted.
Which of the following actions should the nurse take?
Document the event in the client's progress notes.
Submit an incident report to the risk manager.
Inform the client of the APs' actions.
Tell the APs to stop the conversation.
The Correct Answer is D
The correct answer is Choice D.
Choice A rationale: Documenting the event in the client’s progress notes is not the most appropriate action in this situation. The client’s progress notes should contain information about the client’s health status and care, not about staff behavior. Furthermore, documenting this incident in the client’s notes could potentially violate the client’s privacy if the notes are accessed by individuals who do not need to know about the incident.
Choice B rationale: Submitting an incident report to the risk manager is not the most appropriate action in this situation. Incident reports are typically used for events that have caused or have the potential to cause harm to a client, such as medication errors or falls. In this case, while the APs’ behavior is inappropriate, it has not caused harm to the client.
Choice C rationale: Informing the client of the APs’ actions is not the most appropriate action in this situation. Doing so could unnecessarily worry or upset the client. The nurse’s role is to advocate for the client and protect their privacy and dignity, which includes not sharing information about inappropriate staff behavior with the client.
Choice D rationale: Telling the APs to stop the conversation is the most appropriate action in this situation. The nurse has a professional responsibility to address inappropriate behavior by other healthcare team members. Discussing a client in a public area, such as the nurses’ station, is a breach of client confidentiality. The nurse should remind the APs of the importance of maintaining client confidentiality and direct them to stop the conversation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
No explanation
Correct Answer is D
Explanation
Choice A rationale:
"I should use the cap during my menstrual cycle to prevent pregnancy." Rationale: This statement is incorrect. The cervical cap should be used only during sexual intercourse to prevent pregnancy, not during the menstrual cycle. It does not provide protection against sexually transmitted infections (STIs) and should be used in conjunction with a spermicide for effectiveness.
Choice B rationale:
"I should avoid using spermicide with the cervical cap." Rationale: This statement is incorrect. To enhance the effectiveness of the cervical cap, it should be used with a spermicide. Spermicide helps immobilize and kill sperm, providing an additional barrier against pregnancy.
Choice C rationale:
"I need to have my provider check the size of the cap every 6 months." Rationale: This statement is incorrect. While it's important for the healthcare provider to properly fit the cervical cap initially, it does not require routine sizing checks every six months. However, clients should periodically check the cap for any signs of damage or deterioration.
Choice D rationale:
"I need to keep the cap in place for at least 6 hours after intercourse." Rationale: This is the correct statement. To ensure the effectiveness of the cervical cap, it should be left in place for at least six hours after intercourse. It provides a barrier that prevents sperm from reaching the cervix. However, it should not be left in place for more than 48 hours to reduce the risk of toxic shock syndrome.
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