A nurse on a medical-surgical unit is caring for a patient who requests to review his medical record. How should the nurse respond?
“I’m sorry, but you do not have the right to read your chart.”
“You will have to sign a written request for access to your record.”
“We’ll give you a copy of your records when we are preparing you for discharge.”
“You will have to explain why you want to review your medical record.”
The Correct Answer is B
Choice A rationale:
Incorrect. Patients have a legal right to access their medical records under the Health Information Portability and Accountability Act (HIPAA). Denying access is a violation of patient rights and could lead to legal consequences.
Undermines patient autonomy and trust. Patients have a right to know what information is in their medical records and to participate in their own healthcare decisions. Denying access can erode trust in the healthcare system.
Potential for errors and misunderstandings. If patients cannot review their records, they may not be able to identify errors or misunderstandings that could impact their care.
Choice B rationale:
Correct. This response upholds patient rights while ensuring that the request for access is documented and handled appropriately.
Protects patient privacy and confidentiality. The written request process helps to ensure that only the patient or their authorized representative has access to the records.
Provides a mechanism for tracking and auditing access requests. This can help to prevent unauthorized access and ensure compliance with HIPAA regulations.
Choice C rationale:
Incorrect. Patients have a right to access their records at any time, not just when they are being discharged.
Delays access to information. Patients may need to review their records to make informed decisions about their care, even if they are not being discharged.
Potential for records to be lost or misplaced. There is a risk that records could be lost or misplaced if they are not provided to the patient until discharge.
Choice D rationale:
Incorrect. Patients do not need to provide a reason for wanting to access their medical records.
Intrusive and unnecessary. Patients may feel uncomfortable or embarrassed about having to explain their reasons for wanting to access their records.
Potential for discrimination. Patients may be less likely to request access to their records if they feel that they will be judged or questioned about their reasons for doing so.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice B rationale:
Stridor is a high-pitched, whistling sound that is heard during inspiration. It is a sign of upper airway obstruction, indicating a potentially life-threatening complication that requires immediate intervention.
Here's a detailed explanation of why stridor is the most concerning finding and why the other choices are not as indicative of a serious problem:
Stridor:
Mechanism: Stridor occurs when there is narrowing or obstruction of the upper airway, typically at the level of the larynx or trachea. This narrowing can be caused by various factors, including:
Laryngospasm: A sudden constriction of the vocal cords, often triggered by irritation or inflammation. Post-extubation edema: Swelling of the tissues in the airway after removal of the endotracheal tube.
Mucus plugging: Accumulation of thick secretions in the airway, which can partially block airflow.
Vocal cord dysfunction: Impairment of the vocal cords' movement, which can affect their ability to open and close properly.
Significance: Stridor is a serious sign because it indicates that airflow is significantly restricted. If left untreated, upper airway obstruction can lead to hypoxia (low oxygen levels) and respiratory failure.
Nursing intervention: If stridor is present, the nurse should immediately notify the provider and prepare for potential interventions to secure the airway, such as:
Reintubation: Reinserting the endotracheal tube to bypass the obstruction.
Nebulized racemic epinephrine: Medication to reduce swelling in the airway.
Heliox: A mixture of helium and oxygen that can improve airflow through a narrowed airway. Steroids: Medications to reduce inflammation in the airway.
Crackles (Choice A):
Description: Crackles are rattling, crackling sounds heard in the lungs, often during inspiration. They are typically associated with lower airway problems, such as pneumonia or pulmonary edema.
Significance: While crackles can indicate respiratory issues, they are not as immediately concerning as stridor in the context of post-extubation care.
Strong cough (Choice C):
Significance: A strong cough is generally a positive sign after extubation, as it indicates that the patient is able to clear secretions from their airway effectively.
Deep breathing (Choice D):
Significance: Deep breathing is also a positive sign, as it promotes lung expansion and oxygenation.
Correct Answer is D
Explanation
Rationale for Choice A:
Diuretics promote fluid loss, increasing the risk of fluid volume deficit.
Heart failure can lead to fluid retention, but diuretic therapy is often used to manage this excess fluid.
However, in this case, the patient is receiving diuretic therapy, which suggests that their fluid status is being actively managed.
Therefore, while this patient is at risk for fluid volume deficit, they are not the most likely candidate among the options presented.
Rationale for Choice B:
Gastroenteritis can lead to fluid loss through vomiting and diarrhea.
However, this patient is receiving oral fluids, which helps to replenish lost fluids and electrolytes.
As long as the patient is able to tolerate oral fluids and is not experiencing excessive fluid losses, they are not at significant risk for fluid volume deficit.
Rationale for Choice C:
End-stage kidney disease can impair the kidneys' ability to regulate fluid balance.
However, dialysis is a treatment that helps to remove excess fluid and waste products from the body.
Therefore, while this patient is at risk for fluid volume imbalances, they are receiving treatment to manage this risk.
Rationale for Choice D:
NPO status means that the patient has been instructed to have nothing by mouth. This means that the patient has not been able to consume any fluids since midnight.
Even in the absence of excessive fluid losses, this prolonged period of fluid restriction can lead to dehydration and fluid volume deficit.
Therefore, this patient is the most likely to be experiencing fluid volume deficit among the options presented.
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