A nurse is reviewing client confidentiality with other staff members. The nurse should identify which of the following actions is an example of protecting client confidentiality.

Discarding worksheets containing client information in a wastebasket

Writing a client's diagnosis on the message board in the client's room

Giving change of shift report to a nurse outside the client's room

Discussing a client's prognosis with an assistive personnel who is caring for the client

Answer and Explanation

The Correct Answer is C

A. Discarding worksheets containing client information in a wastebasket does not ensure proper disposal of confidential information and could compromise confidentiality.
B. Writing a client's diagnosis on the message board in the client's room could breach confidentiality, as it could potentially be seen by unauthorized individuals.
C. This action protects client confidentiality because it involves discussing sensitive information in a private setting where unauthorized individuals are less likely to overhear. This is an appropriate method of communicating client information during a handoff.
D. While sharing relevant information with personnel directly involved in the client's care is generally acceptable, it must still be done in a manner that safeguards confidentiality.

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Correct Answer is C

Explanation

A. Assisting the client to the bathroom at regular intervals helps prevent falls due to toileting needs.

B. Locking the wheels on the bed prevents unwanted movement and reduces the risk of falls when the client is in bed.

C. Raising all four side rails is considered a restraint, which can increase the risk of falls or injury if the client tries to climb over them. Restraints should be avoided unless absolutely necessary and prescribed by a healthcare provider. In most cases, raising two side rails is sufficient to prevent the client from accidentally rolling out of bed while allowing them to safely exit the bed.

D. Clearing the path from obstacles and furniture reduces the risk of falls by providing a safe and unobstructed route to the bathroom.

A. Measure the client's abdominal girth daily. B. Restrict the client's sodium intake to 3 g per day. C. Keep the client's daily protein intake below 0.8 g/kg. D. Position the client supine with legs elevated.

Correct Answer is A

Explanation

A. Correct. Measuring abdominal girth daily is important to monitor for changes in ascites and fluid retention.
B. Restricting sodium intake is important for clients with ascites to manage fluid retention, but a specific limit of 3 g per day is not universally applicable.
C. Protein intake should not be significantly restricted for clients with ascites; protein is essential for maintaining adequate serum albumin levels.
D. Positioning the client supine with legs elevated might be uncomfortable and not directly related to managing ascites.

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A nurse is reviewing client confidentiality with other staff members. The nurse should identify which of the following actions is an example of protecting client confidentiality.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

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Correct Answer is A

Explanation

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