A nurse is completing the admission process for an older adult client new to the unit. After gathering the assessment data and reviewing the health history, which of the following best promotes client safety?
Conduct a client care conference
Provide information about advance directives
Orient the client to his room
Develop a plan of care
The Correct Answer is C
Choice A reason: Conducting a client care conference is important for multidisciplinary care planning, but it may not immediately address the client's safety needs upon admission. Safety measures should be implemented promptly to prevent potential accidents or confusion.
Choice B reason: Providing information about advance directives is crucial for ensuring that the client's wishes are respected during their care. However, this does not directly address immediate safety concerns that may arise from being in a new environment.
Choice C reason: Orienting the client to his room is essential to promote client safety. This includes familiarizing the client with the layout of the room, location of the bathroom, call bell, and any other essential features. It helps prevent falls and accidents by reducing confusion and ensuring the client knows how to access help if needed.
Choice D reason: Developing a plan of care is critical for long-term management of the client's health needs. However, immediate safety concerns should be addressed first to ensure a safe environment for the client from the outset.
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Correct Answer is B
Explanation
Choice A reason: Libel refers to written statements that are false and damaging to a person's reputation. In this scenario, since the nurses are speaking and not writing, libel is not applicable.
Choice B reason: Invasion of privacy pertains to disclosing private information about an individual without their consent. Discussing a client's medical condition in a public place such as the hospital cafeteria where others can overhear constitutes an invasion of privacy. The client’s right to confidentiality has been violated, which could lead to a formal complaint.
Choice C reason: Slander involves spoken statements that are false and damaging to a person's reputation. While the nurses are speaking, there is no indication that what they are saying is false, so slander is not the applicable concern in this situation.
Choice D reason: Defamation is a broad term that includes both libel and slander, which are false statements made to damage someone's reputation. As mentioned earlier, there is no indication that the statements made by the nurses are false; rather, the issue is the inappropriate sharing of private information.
Correct Answer is B
Explanation
Choice A reason: The red category in the START triage system is assigned to clients who require immediate life-saving intervention. Although this client is in pain and has severe symptoms, their respiratory rate, pulse, and capillary refill are normal, indicating that they do not need immediate life-saving intervention.
Choice B reason: The yellow category is designated for clients whose condition is stable but requires observation. This client is awake, alert, and oriented, with a normal respiratory rate, good radial pulse, and normal capillary refill. While they have severe abdominal pain and nausea, their condition does not appear to be life-threatening, making yellow the appropriate triage level.
Choice C reason: The black category is used for clients who are deceased or have injuries so severe that they are not expected to survive even with immediate medical intervention. This client is stable and responsive, so they do not fall into this category.
Choice D reason: The green category is for clients with minor injuries who can walk and do not require urgent medical attention. Since this client has severe symptoms and needs medical attention, the green category is not appropriate.
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