which behavior is most likely to result in a breach of client confidentiality
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Nursing Elites

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HESI CAT Exam Quizlet

1. Which behavior is most likely to result in a breach of client confidentiality?

Correct answer: B

Rationale: The correct answer is B. Discussing client information in a public area, such as a cafeteria, may lead to breaches of confidentiality. Choice A involves discussing a client's condition in a professional setting, which is not likely to result in a breach as it is for educational purposes. Choice C involves nursing students discussing their assigned client's conditions, which is common in a learning environment and not necessarily a breach of confidentiality. Choice D involves a private conversation between healthcare professionals, which is less likely to result in a breach compared to discussing in a public area like a cafeteria where non-authorized individuals may overhear the conversation.

2. The nurse is assigned to care for four surgical clients. After receiving report, which client should the nurse see first?

Correct answer: B

Rationale: The correct answer is B because the client with continuous bladder irrigation post-bladder surgery is at risk for complications like infection or bleeding. This client requires immediate attention to assess for any signs of complications such as urinary retention, hemorrhage, or infection. Choices A, C, and D have less urgent needs compared to a client with continuous bladder irrigation, which requires priority assessment.

3. The nurse is assessing an infant with pyloric stenosis. Which pathophysiological mechanism is the most likely consequence of this infant’s clinical picture?

Correct answer: B

Rationale: Pyloric stenosis often leads to metabolic alkalosis due to the loss of gastric acid from vomiting. Metabolic acidosis would not be expected in pyloric stenosis as there is no excessive acid accumulation. Respiratory alkalosis and respiratory acidosis are not typically associated with pyloric stenosis, making them incorrect choices.

4. After undergoing an uncomplicated gastric bypass surgery, a client is experiencing difficulty managing their diet. What dietary instruction is most important for the nurse to explain to the client?

Correct answer: A

Rationale: The correct answer is A. Thoroughly chewing food is crucial for clients who have undergone gastric bypass surgery to aid in digestion and prevent complications. Proper chewing helps break down food into smaller particles, making it easier for the digestive system to process. This instruction is essential to prevent issues such as food blockages or inadequate nutrient absorption. Choices B and C are also important for post-gastric bypass clients to maintain proper nutrition and hydration, but they are not as critical as ensuring thorough chewing. Choice D addresses dietary concerns but is not as immediately crucial as ensuring the client chews food properly to support digestion and prevent complications.

5. After removing an IV that became infiltrated in the client’s left forearm, which site should the nurse select as a possible site to insert another IV catheter?

Correct answer: A

Rationale: The correct answer is A: Right hand. When an IV becomes infiltrated in the client's left forearm, it is essential to avoid the same side due to the risk of complications. Therefore, the right hand is a suitable alternative site for IV insertion. Choices B, C, and D are incorrect. Choosing the right forearm (B) would still be on the same side, which increases the risk of complications. The left hand (C) is not a preferred option immediately after an infiltration in the left forearm. The right subclavian (D) is an invasive site typically reserved for central line placement and not a first-line choice for IV insertion.

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