A nurse manager observes an unknown man in a laboratory coat making copies of a client's medical record. Which of the following actions should the nurse plan to take first?
Report the observation to the nurse caring for that client.
Inform the nursing supervisor.
Approach the man and ask why he is making copies.
Notify hospital security.
The Correct Answer is C
Rationale:
A. Reporting the observation to the nurse caring for that client is important but not the immediate priority.
B. Informing the nursing supervisor is necessary but should be done after assessing the situation directly.
C. Approaching the man and asking why he is making copies is the most immediate and direct action. It allows the nurse to assess the situation and determine if the man has legitimate access to the client's medical record or if further action is needed.
D. Notifying hospital security may be necessary if the man’s actions are unauthorized, but the first step is to gather more information.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Reassign the task to another nurse: While reassignment may be an option, it does not address the underlying issue. Ensuring the LPN has the knowledge and skill to complete the task is more effective in addressing both immediate and future concerns.
B. Report the issue to the unit manager: Reporting to the manager might be appropriate if the issue persists or reflects repeated non-compliance. However, verifying the LPN's competence and addressing the problem directly should be the first step.
C. Change the client’s dressing: While changing the dressing resolves the immediate client need, it does not address the issue of delegation or why the task was not completed. This approach bypasses the opportunity to assess and support the LPN.
D. Verify the LPN knows how to do a dressing change: Before taking further action, the charge nurse should determine why the task was not completed. If the LPN lacks the knowledge or skill to perform a dressing change, the nurse must address this gap and provide appropriate education or support to ensure client care is not compromised.
Correct Answer is ["A","B","D"]
Explanation
Rationale:
A. Check the position of a client in soft wrist restraints is appropriate for an AP as it involves routine monitoring and ensuring the client's safety.
B. Accompany a client who has depression to occupational therapy is a task that can be assigned to an AP, as it involves providing support and ensuring the client's safe arrival to therapy.
C. Set limits with a client who has mania is not appropriate for an AP, as this involves therapeutic communication and behavior management, which requires nursing judgment.
D. Sit with a client who has alcohol use disorder and whose last drink was five days ago can be assigned to an AP as it involves providing a supportive presence and monitoring, but the nurse should assess for withdrawal symptoms.
E. Assess a client who has hypomania for exhaustion is a nursing responsibility that involves evaluation and judgment, making it inappropriate to delegate to an AP.
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