The practical nurse (PN) overhears a conversation between an unlicensed assistive personnel (UAP) and another staff member in the hospital cafeteria line concerning a client's reaction to being given a diagnosis of terminal cancer. What is the best nursing action?
Try not to listen to the conversation since it is confidential.
Write an incident report and submit it to the unit manager.
Approach the individuals involved and ask them to stop.
Tell the client of the UAP's concern for him.
The Correct Answer is C
A. Trying not to listen to the conversation does not address the issue of confidentiality breach or protect the client's privacy.
B. Writing an incident report might be necessary, but the immediate action should be to stop the conversation to protect the client's confidentiality.
C. Approaching the individuals involved and asking them to stop is the most appropriate and immediate action to protect the client's privacy and confidentiality.
D. Telling the client about the UAP's concern might not be suitable without context or proper consent, and it might not address the confidentiality breach.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Encourage the client to resume normal activities after medication administration. - This action could exacerbate the injury and pain and isn't appropriate after pain medication for a fracture.
B. Implement ongoing assessments for signs of shallow or slow breathing. - Hydrocodone, an opioid, can cause respiratory depression. Regular monitoring for respiratory changes is crucial.
C. Observe the client for involuntary movements of the lips and tongue. - This might indicate adverse reactions but is not the most critical concern after administering hydrocodone/acetaminophen.
D. Assess the skin daily for areas of ecchymosis or other signs of bleeding. - While monitoring for bleeding is important, it's not the immediate concern following administration of hydrocodone/acetaminophen.
Correct Answer is C
Explanation
A. Checking for kinks in the drainage tubing is important, but the observed clots and thick red fluid suggest potential complications that require immediate attention and should be reported. B. Waiting for an hour to observe again could delay necessary interventions if there's an issue with bleeding or clot formation, so reporting immediately is more prudent.
C. Reporting the finding to the charge nurse is crucial as it indicates potential complications such as bleeding or clot formation that need immediate intervention.
D. Stopping the irrigation solution without proper assessment and guidance could lead to complications and isn't the initial action warranted in this situation. Reporting to a superior nurse allows for prompt evaluation and intervention.
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