ons should the nurse take? Refer all media inquiries to the nursing supervisor. The HIPAA Privacy Rule prohibits disclosing client information to individuals who are not involved in care without the client's express consent. The reporter should be told that, due to confidentiality issues, no information can be given about any client. The nurse should refer the reporter to the nursing supervisor. A nurse is documenting data about a client at a computer terminal in the nurses' station when he has to leave the area to assist another client. Which of the following actions should the nurse take? Log off the computer before leaving the nurses' station. To ensure no one else has access to the client's protected health information, the nurse should log off the computer terminal and turn off the monitor. While caring for a client, a nurse notices that the client's call light cord is frayed. Which of the following actions should the nurse take? Replace the call light and send the frayed one to the repair department. For client safety, the client needs to have access to a call light to notify the nursing staff for assistance. A frayed cord is an electrical hazard. Removal of a frayed cord is the best way to protect the client from potential electrical shocks or burns. A charge nurse is teaching a group of unit nurses about alternative restraints for clients who are confused and wandering. Which of the following pieces of information should the nurse include in the teaching? Provide the client with a rocking chair. The nurse should advise providing the client with a rocking chair to expend some of the client's energy through rocking rather than walking, which leads to wandering. A nurse is working with an assistive personnel (AP) in a long-term care facility. According to the 5 rights of delegation, which of the following determinations should the nurse make prior to assigning tasks? The degree of supervision that the AP will require to complete the task. Successful delegation involves assigning the right task to the right person under the right circumstances. The person who will perform the task must be given adequate direction and specification regarding the amount of supervision that will be provided. The right communication of expectations and the right feedback about performance must also be supplied. An experienced nurse is serving as a mentor to a newly licensed nurse. Which of the following actions should the mentor take? Serve as a guide and teacher for the newly licensed nurse in an established relationship. A mentor establishes a nurturing relationship with a newly licensed nurse and is willing to invest time and resources to help this person develop as a nurse and an individual. A nurse is preparing to give a change-of-shift report to the oncoming nurse. Which of the following pieces of information should the nurse include? Objective measurements about the client's condition. The nurse should include objective observations and measurements about the client's condition in the report. A nurse is discussing palliative care with the family of a client who is terminally ill. Which of the following should the nurse include as the purpose of palliative care? Providing comfort measures. Palliative care is an approach to care that promotes comfort for a client who has a terminal diagnosis and is not receiving aggressive therapy. Palliative care focuses on managing manifestations of the disease, not on curing the disease. A nurse is preparing to attend a care plan conference for a client who has severe burns. Which of the following criteria should the nurse identify as part of an effective conference? Other health care professionals are in attendance at the conference. The nurse should identify that an effective conference should consist of other health care professionals who contribute to the plan of care for goal setting and seek to establish positive client outcomes. The members of the conference consist of the nursing team who should invite other health professionals (e.g. physical therapists, dieticians, and occupational therapists) to contribute to the plan of care. A nurse is caring for a client who received a sedative-hypnotic medication at bedtime. The client gets out of bed and falls, sustaining a laceration that requires suturing. Which of the following statements should be included as part of the nurse's documentation in the client's chart? "Client found sitting on floor with 3 cm laceration above left eyebrow. Oriented to name only. Provider notified." This statement is appropriate to include in the documentation. It presents objective facts and assessments related to this event. The nurse should also include vital signs, further assessments, the name of the provider notified, treatments or procedures that were done per the provider's prescription, and the client's response. A nurse is delegating a client care task to an assistive personnel (AP). Which of the following directions should the nurse give the AP? "This client needs to ambulate using a walker three times today." This direction includes the type of task to be done, the frequency with which the task is to be performed, the duration of the task, and information about the mechanics of ambulating the client. A nurse is preparing a client for discharge. The client states, "My partner hurts me. I don't want to go home." Which of the following actions should the nurse take? Refer the client to social services for assistance in seeking safe housing A charge nurse is observing a group of newly licensed nurses. Which of the following actions should the charge nurse report to the nurse manager as a violation of HIPAA? Talking about clients with other nurses in the cafeteria. The nurse should not discuss information about clients—including their personal concerns, diagnoses, and treatments—with anyone who is not directly involved in the client's care. Doing so is a violation of HIPAA regulations. Nurses should take special care not to compromise this right by discussing client care in such places as elevators, restaurants, or other areas that are accessible to the public in which the discussion might be overheard. A nurse is teaching a group of newly licensed nurse managers about the principle of justice. Which of the following statements by a nurse manager indicates an understanding of this teaching? "I will compose staf f schedules so that each person works two holidays a year." Justice means treating everyone fairly. By scheduling each person to work two holidays per year, the nurse manager is requiring staff members to work an equal share of holidays. A nurse manager believes that a nurse is taking breaks that are too frequent and lengthy. Which assertive statement should the charge nurse use to initiate a discussion of the issue? "I understand you are allowed to take scheduled breaks during each shift, but you are taking more than the number allocated. Let's set a time when we can discuss this behavior." Assertive communication uses "I" statements that describe the person's observations and feelings. It allows the person being confronted to respond to the issue with his/her own perceptions and feelings instead of feeling verbally assaulted. Subsequently, a verbal discourse can follow that allows an open discussion of the issue. An RN is preparing assignments for the upcoming shift. Which of the following tasks should the charge nurse delegate to a licensed practical nurse (LPN)? Performing tracheostomy suctioning for a client who is stable. An RN may delegate the task of performing tracheostomy suctioning for a client who is stable or whose tracheostomy is not new to the LPN. This task is within the LPN's scope of practice. A nurse is providing teaching for new parents on safe sleeping recommendations to reduce the risk of sudden infant death syndrome (SIDS). Which of the following instructions should the nurse include? "Room sharing is recommended while the infant sleeps." Sharing a room during sleep has been found to decrease the incidence of SIDS. However, infants should have their own sleep space, such as a crib or bassinet. Bed sharing is not recommended. A nurse is administering medications to a client who is recovering from a stroke and has right-sided paralysis. The nurse places the client's medications on the left side of the mouth and administers pills one at a time. Which of the following ethical principles is the nurse displaying? Nonmaleficence. Nonmaleficence is the duty to do no harm and to protect clients from harm by eliminating threats. These actions taken by the nurse are important for the safety of the client by preventing aspiration. A nurse is planning care for several clients. Which of the following clients should the nurse refer to a case manager? A client who has neurological deficits following a stroke. The nurse should refer this client to the case manager for care. A client who had a stroke will likely require long-term treatment. A client who has ongoing needs for care or rehabilitation should receive care that is directed by a case manager due to the complexity and cost of the client's needs. A nurse is teaching a newly licensed nurse about advanced directives. Which of the following statements by the newly licensed nurse indicates an understanding of this teaching? "I will assess the client's understanding of life-sustaining measures." The nurse needs to assess whether the client has an accurate understanding of life- sustaining measures in order to make informed decisions in advance directives. A nurse is caring for a male client who is scheduled for a procedure. The client's son asks