The charge nurse is assisting a nurse in the admission process for a patient with multiple chronic conditions.
Which action taken by the nurse demonstrates a breach of confidentiality to the charge nurse?

Shares the health history with case manager.

Discusses diagnoses with the physical therapist.

Provides a list of food allergies to nutritional services.

Requests military records by phone.

Answer and Explanation

The Correct Answer is D

Requesting military records by phone without the patient’s consent would be a breach of confidentiality.

Choice A is incorrect because sharing the health history with a case manager who is involved in the patient’s care would not be a breach of confidentiality.

Choice B is incorrect because discussing diagnoses with a physical therapist who is involved in the patient’s care would not be a breach of confidentiality.

Choice C is incorrect because providing a list of food allergies to nutritional services who are involved in the patient’s care would not be a breach of confidentiality.

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Correct Answer is D

Explanation

Prior to performing digital removal of a fecal impaction, it is important for the nurse to assess the client’s vital signs.

This includes checking the client’s blood pressure, pulse rate, respiratory rate, and temperature.

These measurements can provide important information about the client’s overall health status and can help the nurse determine if it is safe to proceed with the procedure.

Choice A is not correct because abdominal girth is not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.

Choice B is not correct because breath sounds are not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.

Choice C is not correct because bowel sounds are not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.

A. "Tell me about the visit with your significant other.". B. "I can see that you are feeling lonely.". C. "Would you like to talk for a while?". D. "What did you enjoy about your visit tonight?".

Correct Answer is C

Explanation

This response shows that the nurse is willing to listen and provide support to the client.

It also allows the client to decide if they want to talk and share their feelings.

Choice A is not correct because it is not the most therapeutic response.

While it does encourage the client to talk about their visit with their significant other, it does not show that the nurse is willing to listen and provide support.

Choice B is not correct because it is not the most therapeutic response.

While it does acknowledge that the client may be feeling lonely, it does not show that the nurse is willing to listen and provide support.

Choice D is not correct because it is not the most therapeutic response.

While it does encourage the client to talk about their visit, it does not show that the nurse is willing to listen and provide support.

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The charge nurse is assisting a nurse in the admission process for a patient with multiple chronic conditions. Which action taken by the nurse demonstrates a breach of confidentiality to the charge nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Prior to performing digital removal of a fecal impaction, what is the most important assessment for the nurse to perform?

Correct Answer is D

Explanation

Which response by the nurse is most therapeutic?

Correct Answer is C

Explanation

A client presents to the doctor's office with a report of fatigue and difficulty sleeping. Which information should the nurse recognize as a potential contributing factor?

An accident arrives at the emergency department (ED) with severe right lower quadrant abdominal pain. To assess the intensity of the client's pain, which approach should the nurse use?

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The charge nurse is assisting a nurse in the admission process for a patient with multiple chronic conditions.
Which action taken by the nurse demonstrates a breach of confidentiality to the charge nurse?