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?

Tell the APS to stop the conversation.

Document the event in the client's progress notes.

Inform the client of the APs' actions.

Submit an incident report to the risk manager.

Answer and Explanation

The Correct Answer is A

A.   Correct. Overhearing private client information being discussed by staff members violates the client's right to privacy and confidentiality. The nurse should address the situation immediately and instruct the assistive personnel to stop the conversation.
B.   Incorrect. While documenting the event in the client's progress notes may be necessary, addressing the inappropriate behavior of the assistive personnel takes precedence.
C.   Incorrect. Informing the client about the conversation is not necessary and may further compromise the client's sense of privacy.
D.   Incorrect. Submitting an incident report to the risk manager might be necessary, but the immediate action should be to stop the conversation and address the breach of confidentiality.

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Correct Answer is D

Explanation

The correct answer is Choice D.

Choice A rationale: It’s normal for a 4-year-old child to ask the same questions repeatedly. This is a part of their learning process as they are trying to understand the world around them. They often ask the same questions to reassure themselves about the consistency and predictability of the world. However, this is not a priority issue compared to the other options.

Choice B rationale: While it’s important for children to have a balanced diet, including green vegetables, it’s also common for children to be picky eaters. Parents can introduce new foods gradually and make meal times fun to encourage children to eat a variety of foods. However, this is not a priority issue compared to the other options.

Choice C rationale: Bedwetting is common in children and can be a part of their development. Most children outgrow bedwetting by the time they start school. However, if the child is stressed or has a medical condition, it could lead to bedwetting. While this could be a concern, it’s not the priority issue in this scenario.

Choice D rationale: A change in behavior, such as becoming withdrawn, can be a sign of emotional distress in a child. This could be due to a variety of reasons, including changes in their environment like switching day care providers. This is the priority for the nurse to address as it could indicate that the child is having difficulty adjusting to the new day care, which could impact their emotional well-being.

A. Don gloves prior to assisting the client with brushing their teeth. B. Place the client in a room with high-efficiency particulate air (HEPA. filter. C. Ensure that the negative air pressure is active for the client's room. D. Have the client wear a mask when they are out of their room.

Correct Answer is A

Explanation

A. Correct. MRSA is spread through direct contact with infected skin or surfaces. Wearing gloves when providing care to a client with MRSA helps prevent the spread of the bacteria.
B. Incorrect. The use of HEPA filters and negative air pressure is typically reserved for airborne infections such as tuberculosis. MRSA is primarily spread through direct contact.
C. Incorrect. Negative air pressure is not typically necessary for preventing the spread of MRSA, which is primarily spread through contact.
D. Incorrect. Wearing a mask when out of the room is not a standard precaution for MRSA, which is not primarily transmitted through the airborne route.

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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?

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