When is a nurse legally obligated to breach confidentiality?

When the client violates the nurse’s boundaries

If threats are made to an identifiable third party

Whenever the client becomes aggressive

At any time a client does not agree with the nurse

Answer and Explanation

The Correct Answer is B

Choice A reason: Violating a nurse’s boundaries, such as inappropriate behavior, does not legally mandate breaching confidentiality. Ethical responses involve setting boundaries or reporting within the care team, but confidentiality is protected unless harm to others is threatened, making this situation insufficient for a legal breach.

Choice B reason: Nurses are legally obligated to breach confidentiality when a client makes credible threats to harm an identifiable third party (Tarasoff duty). This protects potential victims by ensuring warnings or interventions occur, balancing patient confidentiality with public safety, as harm prevention takes precedence in mental health law.

Choice C reason: Client aggression does not automatically warrant breaching confidentiality unless it involves specific threats to identifiable individuals. Aggression is managed within the care setting, and confidentiality is maintained unless legal criteria, like imminent harm to others, are met, making this option incorrect.

Choice D reason: Disagreement with the nurse does not justify breaching confidentiality. Ethical care respects client autonomy, and confidentiality is protected unless legal exceptions, like threats or court orders, apply. Disagreement is managed through therapeutic communication, not by disclosing private information, making this an invalid reason for breach.

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Correct Answer is D

Explanation

Choice A reason: Improved nutritional status could cause weight gain but is unlikely in AKI with minimal urine output. AKI patients often have anorexia or dietary restrictions, and weight gain from nutrition would not align with oliguria, which suggests fluid retention rather than increased tissue mass from improved nutrition.

Choice B reason: A 3-pound weight gain in 48 hours with minimal urine output is clinically significant in AKI, indicating fluid retention. Normal weight fluctuations are minimal, and this rapid gain, coupled with oliguria, suggests impaired kidney function, potentially leading to fluid overload complications like hypertension or pulmonary edema.

Choice C reason: Early AKI recovery involves increased urine output (diuresis phase), not minimal output. Weight gain with oliguria indicates ongoing kidney dysfunction, not recovery. Recovery would show improved glomerular filtration and urine production, reducing fluid retention, making this finding inconsistent with AKI recovery.

Choice D reason: In AKI, minimal urine output (oliguria) reflects impaired kidney filtration, leading to fluid retention. A 3-pound weight gain in 48 hours corresponds to approximately 1.5 liters of fluid, indicating fluid overload. This can cause hypertension, pulmonary edema, or heart failure, making fluid retention the most likely explanation.

A. I will have to get the client’s signed consent before we can send that information to you B. I will forward your call to the client’s doctor to discuss consent C. I cannot confirm nor deny the existence of any client on this unit D. I am sorry, we are not allowed to give out information about our clients

Correct Answer is A

Explanation

Choice A reason: HIPAA requires client consent to disclose protected health information, like psychological evaluations, to third parties such as employers. This response upholds confidentiality laws, ensuring the client’s privacy is protected while clearly communicating the legal process for information release, making it the most appropriate and compliant action.

Choice B reason: Forwarding the call to the doctor delays the response and does not directly address the confidentiality requirement. While the doctor may handle consent, the nurse can directly inform the employer about the need for signed consent, maintaining clarity and legal compliance in protecting patient privacy.

Choice C reason: Refusing to confirm or deny the client’s presence is overly restrictive and not necessary for an employer’s request. It avoids addressing the consent process, which is the legal requirement for releasing information, making it less direct and potentially confusing in this context.

Choice D reason: Stating that information cannot be given is accurate but incomplete, as it does not explain the consent process. Providing a clear path (obtaining signed consent) ensures compliance with confidentiality laws while addressing the employer’s request, making this response less precise than option a).

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When is a nurse legally obligated to breach confidentiality?

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

A nurse working on a psychiatric unit receives a telephone call from a client’s employer requesting a copy of the client’s psychological evaluation results. Based on the nurse’s knowledge of breach of confidentiality, which response would be appropriate?

Correct Answer is A

Explanation

A nurse is caring for a client who is in the diuresis phase of acute kidney injury. The nurse should closely monitor the client for what complication during this phase?

A client with a history of chronic renal failure receives hemodialysis treatment three times per week through an arteriovenous (AV) fistula in the left arm. Which priority intervention should the nurse include in the care plan?

The nurse is caring for an acutely ill client. Which assessment finding should prompt the nurse to inform the healthcare provider that the client may be exhibiting signs of acute kidney injury (AKI)?

Which of the following is true regarding mental health and mental illness?

Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?

The nurse recognizes that the difference between a voluntary and an involuntary commitment is what?

The nurse is performing an admission assessment for a client on the behavioral health unit with depression and anxiety. Which goal of therapeutic communication will the nurse prioritize?

A nurse is planning the discharge of a client with a mental health disorder. Which factor does the nurse identify as the best chance for the client to remain in the community without readmission?