A nurse overhears two assistive personnel discussing a client's medical history in the hallway. Which of the following actions should the nurse take first?

Report the incident to the charge nurse.

Participate in an in-service about client confidentiality.

Tell the staff members to stop their discussion.

Speak to the staff members in private about client confidentiality.

Answer and Explanation

The Correct Answer is C

a. While reporting the incident is important, the priority is to stop the confidentiality breach immediately to protect the client's privacy.

b. Participating in training is important for long-term education, but it does not address the immediate issue of the confidentiality breach.

c. Tell the staff members to stop their discussion: This action stops the breach immediately and protects the client's confidential information, which is the first and most crucial step.

d. Speak to the staff members in private about client confidentiality: While this is a good follow-up action to educate and prevent future breaches, the immediate need is to stop the ongoing discussion

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Correct Answer is A

Explanation

This statement should be included in the change-of-shift report because it provides vital information about the patient’s condition and any changes that have occurred to the patient during the shift.

Statement B is wrong because it does not provide relevant information about the patient’s current condition or changes that have occurred during the shift. Statement C is wrong because it does not provide relevant information about the patient’s medical condition. Statement D is wrong because it does not provide new information about changes that have occurred during the shift.

Change-of-shift reports are key to inpatient care because they provide vital information about and responsibility for the patient from the off-going provider to the on-coming provider.

A. Encourage the client to drink 3,000 mL of ﬂuid daily. B. Change the indwelling urinary catheter tubing every 3 days. C. Place the drainage bag on the bed when transporting the client. D. Empty the drainage bag when it is half-full. E. Review the need for the indwelling urinary catheter daily. F. Use soap and water to provide perineal care.

Correct Answer is ["A","D","E","F"]

Explanation

To decrease the risks of a urinary tract infection for this client, the nurse should take several actions. The nurse should encourage the client to drink 3,000 mL of ﬂuid daily to help ﬂush bacteria out of the urinary tract¹. The nurse should also empty the drainage bag when it is half-full to prevent bacterial growth¹.

Additionally, the nurse should review the need for the indwelling urinary catheter daily and use soap and water to provide perineal care¹.

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A nurse overhears two assistive personnel discussing a client's medical history in the hallway. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing change-of-shift report for a client. Which of the following information should the nurse include in the report?

Correct Answer is A

Explanation

Correct Answer is ["A","D","E","F"]

Explanation

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