A nurse on a medical-surgical unit receives a telephone call from an individual who identifies himself as the client's employer.
The employer asks the nurse about the client's condition.
Which of the following is an appropriate response by the nurse?

"The client's condition is stable right now.”.

"I will tell him you called.”.

"I cannot confirm or deny that we have a client by that name.”.

"He is here in the hospital, but I cannot tell you anything else.”. . .

Answer and Explanation

The Correct Answer is C

Choice A rationale

Stating that the client's condition is stable right now is a breach of patient confidentiality and does not comply with privacy regulations.

Choice B rationale

Telling the employer that the nurse will inform the client about the call is also a breach of confidentiality, as it implies that the client is indeed there.

Choice C rationale

Responding with "I cannot confirm or deny that we have a client by that name" is an appropriate and professional way to protect patient confidentiality and comply with privacy laws.

Choice D rationale

Stating that the client is in the hospital but not providing further details still reveals the client's location, which breaches patient confidentiality and privacy regulations. .

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Correct Answer is D

Explanation

Choice A rationale

Keeping the client's room well lit is not typically beneficial for pain management and may even be counterproductive for clients who need rest or reduced sensory stimuli to manage pain effectively.

Choice B rationale

Encouraging the client to abstain from distracting activities is not recommended. Distraction techniques, such as engaging in activities, can be effective in reducing the client's perception of pain.

Choice C rationale

Ensuring that the client's room is kept at a cool temperature may not be effective for pain relief and might cause discomfort, especially if the client prefers warmth.

Choice D rationale

Playing music in the client's room can serve as a distraction and has been shown to reduce the perception of pain. Music therapy can induce relaxation, reduce anxiety, and create a calming environment.

A. Placing the cap of a sterile solution on a clean surface with the inside facing down. B. Placing a sterile instrument within 1.3 cm (0.5 in) of the edge of the sterile field. C. Opening the top flap of the sterile tray package away from their body. D. Dropping sterile objects onto the field from a height of 5 cm (2 in). .

Correct Answer is C

Explanation

Choice A rationale

Placing the cap of a sterile solution on a clean surface with the inside facing down can contaminate the cap. It should be placed with the inside facing up to maintain sterility.

Choice B rationale

Placing a sterile instrument within 1.3 cm (0.5 in) of the edge of the sterile field risks contamination, as the edges are considered non-sterile. Instruments should be placed well within the sterile field.

Choice C rationale

Opening the top flap of the sterile tray package away from their body ensures that the sterile contents are not contaminated by the nurse's clothing or body, maintaining the sterility of the field.

Choice D rationale

Dropping sterile objects onto the field from a height of 5 cm (2 in) can cause contamination due to the potential for the objects to fall outside the sterile field. Objects should be placed gently onto the field without dropping them.

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A nurse on a medical-surgical unit receives a telephone call from an individual who identifies himself as the client's employer.The employer asks the nurse about the client's condition.Which of the following is an appropriate response by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing nonpharmacological interventions for a client who is experiencing pain.Which of the following actions should the nurse take?

Correct Answer is D

Explanation

A nurse is setting up a sterile field in a client's room.Which of the following actions should the nurse take?

Correct Answer is C

Explanation

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A nurse on a medical-surgical unit receives a telephone call from an individual who identifies himself as the client's employer.The employer asks the nurse about the client's condition.Which of the following is an appropriate response by the nurse?

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A nurse on a medical-surgical unit receives a telephone call from an individual who identifies himself as the client's employer.
The employer asks the nurse about the client's condition.
Which of the following is an appropriate response by the nurse?