A nurse working on a medical-surgical unit is managing the care of four clients. The nurse should schedule an interdisciplinary conference for which of the following clients?
A client who is receiving heparin and has an aPTT of 34 seconds (30 to 40 seconds).
A client who has type 1 diabetes mellitus and uses an insulin pump.
A client who has orthostatic hypotension and is receiving IV fluids,
A client who is at risk for pressure injuries and has an albumin level of 4.2 g/dL (3.5 to 5 g/dL).
The Correct Answer is B
A. The client’s aPTT is within the therapeutic range for heparin, so immediate interdisciplinary discussion is not required.
B. Clients using insulin pumps require coordination between the nurse, endocrinologist, and diabetes educator to ensure safe insulin administration and blood glucose management, making an interdisciplinary conference appropriate.
C. Orthostatic hypotension being managed with IV fluids can typically be addressed within routine nursing care without needing an interdisciplinary meeting.
D. The client’s albumin level is within normal limits, and risk for pressure injuries can be managed with standard nursing interventions without requiring a conference.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: This is not the correct choice because recommending the son meet with the provider to get information about his mother's condition is not the first action the nurse should take. The nurse should first stop the unauthorized access to the client's records and protect the client's privacy and confidentiality. The nurse can then offer to arrange a meeting with the provider if the son has questions or concerns.
Choice B reason: This is not the correct choice because completing an incident report regarding the breach of the client's confidentiality is not the first action the nurse should take. The nurse should first intervene to prevent further disclosure of the client's information and secure the computer. The nurse can then document the incident and follow the facility's policy and procedure for reporting such events.
Choice C reason: This is the correct choice because logging out the computer so that the client's son is unable to view his mother's information is the first action the nurse should take. The nurse should act quickly and assertively to terminate the unauthorized access to the client's records and safeguard the client's rights. The nurse should also explain to the son why his action was inappropriate and how it violated the client's confidentiality.
Choice D reason: This is not the correct choice because reporting the possible violation of client confidentiality to the nurse manager is not the first action the nurse should take. The nurse should first address the immediate situation and ensure that the client's information is no longer accessible to the son. The nurse can then inform the nurse manager and the provider about the incident and the actions taken.
Correct Answer is B
Explanation
Choice A reason: The client needs to have someone come in to help her bathe at home is not a data that supports a referral for a social worker, as it is a need for home health care or personal care assistance. The nurse should refer the client to a home health agency or a community resource that provides such services.
Choice B reason: The client needs to arrange financial resources to purchase equipment is a data that supports a referral for a social worker, as it is a need for financial assistance or counseling. The nurse should refer the client to a social worker who can help the client access available resources, such as insurance, grants, or loans, to cover the cost of the equipment.
Choice C reason: The client needs to have someone bring oxygen tanks and equipment to her home is not a data that supports a referral for a social worker, as it is a need for oxygen therapy or equipment delivery. The nurse should refer the client to a respiratory therapist or a durable medical equipment company that can provide the oxygen and the equipment.
Choice D reason: The client needs to have range-of-motion exercises to assist with ambulation is not a data that supports a referral for a social worker, as it is a need for physical therapy or rehabilitation. The nurse should refer the client to a physical therapist or a rehabilitation center that can provide the exercises and the guidance.
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