In a Plan-Do-Study-Act cycle for a unit quality project, the Study step involves:

Analysing data to see whether the change worked

Rolling the change out across the whole hospital at once

Teaching all staff how to carry out the new procedure

Choosing the change to test and predicting the results

The main purpose of completing an incident (occurrence) report is to:

Identify system problems so risk can be reduced

Provide a basis for disciplining the staff

Record which staff member caused the adverse event

Replace the nurse's note about the event

A client is told that his HIV test is positive. He says, "Please don't tell anyone, not even the health department." What is the nurse's best response?

HIV is reported to the health department, which keeps it confidential.

I will need to tell your wife myself before you are discharged.

You control who learns your status, so no report will be made.

I can leave the diagnosis out of your chart if you prefer that.

A nurse wants to write online about a meaningful shift at work. Which plan follows professional social-media guidance?

Share general reflections with no client details

Post only in a closed group for unit coworkers

Remove the post within a day of sharing it

Post a photo after cropping out the client's face

Which newly diagnosed condition must the nurse make sure is reported to the local or state health department?

Escherichia coli urinary infection

Streptococcal pharyngitis in a teen

Confidentiality, reporting, quality and equitable care

46 NCLEX-RN practice questions on Confidentiality, reporting, quality and equitable care, part of Management of Care. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
In a Plan-Do-Study-Act cycle for a unit quality project, the Study step involves:
1. ARolling the change out across the whole hospital at once
2. BTeaching all staff how to carry out the new procedure
3. CAnalysing data to see whether the change worked
4. DChoosing the change to test and predicting the results
Show answerHide answer
Answer: C · Analysing data to see whether the change worked
PDSA is a small-test-of-change model used in quality improvement. In Plan the team chooses a change and predicts the result; in Do it tests the change on a small scale; in Study it analyses the data against the prediction; in Act it adopts, adapts or abandons the change. Studying results prevents spreading a change that does not work. This item maps to evaluating outcomes.
- A: Spreading the change belongs to Act, after results are studied.
- B: Carrying out the change on a small scale is the Do step.
- D: Selecting the change and predicting results happen in Plan.
Question 2 · Easy
The main purpose of completing an incident (occurrence) report is to:
1. AProvide a basis for disciplining the staff
2. BRecord which staff member caused the adverse event
3. CReplace the nurse's note about the event
4. DIdentify system problems so risk can be reduced
Show answerHide answer
Answer: D · Identify system problems so risk can be reduced
Incident reports are quality and risk-management tools. They collect data on unexpected events so the organisation can find patterns and fix the processes that allowed them. They are not part of the medical record and are not meant to assign blame. The nurse still documents the facts of the event and the care given in the client's record.
- A: Using reports for punishment undermines a culture of safety.
- B: Blame-free reporting is the aim; naming a culprit discourages reporting.
- C: The clinical facts and care must still be charted in the medical record.
Question 3 · Hard
A client is told that his HIV test is positive. He says, "Please don't tell anyone, not even the health department." What is the nurse's best response?
1. AI will need to tell your wife myself before you are discharged.
2. BYou control who learns your status, so no report will be made.
3. CI can leave the diagnosis out of your chart if you prefer that.
4. DHIV is reported to the health department, which keeps it confidential.
Show answerHide answer
Answer: D · HIV is reported to the health department, which keeps it confidential.
HIV infection is reportable in every US state, so the nurse cannot promise that no report will be made. The nurse explains honestly that the report goes to the health department, which protects the information, and that it helps link clients to care. Partner notification is arranged by the provider or health department, not by the bedside nurse acting alone. Omitting a diagnosis from the record is falsification. This item tests generating a solution that is honest and legal.
- A: Partner notification follows a set process; a nurse does not disclose to a spouse alone.
- B: A false promise of no report breaks the law and the client's trust.
- C: Leaving a diagnosis out of the record is falsification and unsafe.
Question 4 · Easy
A nurse wants to write online about a meaningful shift at work. Which plan follows professional social-media guidance?
1. AShare general reflections with no client details
2. BPost only in a closed group for unit coworkers
3. CRemove the post within a day of sharing it
4. DPost a photo after cropping out the client's face
Show answerHide answer
Answer: A · Share general reflections with no client details
NCSBN guidance says nurses must never post information or images that could identify a client, and that a combination of details (room, diagnosis, date, a tattoo) can identify a person even without a name or face. General reflections that contain no client information are acceptable. Privacy settings and deleting a post do not make it confidential, because content can be copied or saved first. The item tests generating a safe solution.
- B: Closed groups are not private; any member can copy and share the content.
- C: Deleted posts may already have been saved or shared, so deletion does not undo a breach.
- D: A cropped photo can still identify the client by the setting, body features or timing.
Question 5 · Medium
Which newly diagnosed condition must the nurse make sure is reported to the local or state health department?
1. AEscherichia coli urinary infection
2. BActive pulmonary tuberculosis
3. CCommunity-acquired pneumonia
4. DStreptococcal pharyngitis in a teen
Show answerHide answer
Answer: B · Active pulmonary tuberculosis
Tuberculosis is a nationally notifiable disease, and every state requires a report so the health department can trace contacts and ensure directly observed therapy. Reporting is a legal exception to confidentiality, and the health department keeps the information confidential. The nurse confirms the report is made per facility policy, usually through infection prevention. Common infections such as strep throat, routine pneumonia or E. coli cystitis are not individually reportable.
- A: A single E. coli urinary infection is not a notifiable condition.
- C: Routine pneumonia without a notifiable cause such as Legionella is not reported.
- D: Individual cases of strep throat are not reportable; outbreaks may be.
Question 6 · Hard
During orientation the nurse educator reviews social-media use. Which statement by a new nurse indicates a need for further teaching?
1. ADiscussing a client in our private unit group is acceptable.
2. BI'll report any coworker post that could identify a client.
3. CI won't accept friend requests from clients in my care.
4. DComments about my employer can affect my nursing license.
Answer and explanation in LearnFree account
Question 7 · Medium
A male client asks that his husband stay overnight. A coworker says, "Only spouses of the opposite sex count as family here." Visiting policy lets clients choose their own visitors. What should the nurse do?
1. AExplain that the client chooses his own visitors
2. BAvoid conflict and leave the decision to night shift
3. CAsk the husband to show proof of their marriage
4. DLet the husband stay only if the client gets worse
Answer and explanation in LearnFree account
Question 8 · Hard
A medical unit recorded 4 client falls in March over 1,600 patient-days. What is the fall rate per 1,000 patient-days?
1. A0.25
2. B25
3. C4
4. D2.5
Answer and explanation in LearnFree account
Question 9 · Easy
Under HIPAA, which disclosure of a client's health information may the nurse make without the client's written authorization?
1. AFaxing the client's records to his life insurer at its request
2. BTelling the client's adult daughter the results when she phones
3. CSharing findings with the consulting provider
4. DDescribing the case to a nurse friend who works elsewhere
Answer and explanation in LearnFree account
Question 10 · Hard
A quality team is tracking a pressure-injury prevention project. Which measure is an outcome measure?
1. APercentage of clients repositioned every 2 hours as ordered
2. BNumber of pressure-redistributing mattresses on the unit
3. CRate of hospital-acquired stage 2 or deeper pressure injuries
4. DPercentage of admissions with a Braden score documented
Answer and explanation in LearnFree account
Question 11 · Hard
A well-known local politician is admitted after a car crash. Which person may the nurse allow to review the client's electronic record?
1. AThe physical therapist assigned to him today
2. BThe unit clerk who wants to know why he was admitted
3. CA nurse from another unit who cared for him last year
4. DHis chief of staff, who needs to brief the news media
Answer and explanation in LearnFree account
Question 12 · Medium
A transgender woman is admitted to a medical unit. Which nursing action best shows unbiased, respectful care?
1. AAvoid all questions about gender to prevent offence
2. BUse the name on her insurance card when speaking with her
3. CRefer questions about her identity to the social worker
4. DAsk which name and pronouns she wants staff to use
Answer and explanation in LearnFree account
Question 13 · Hard
Day 1 after the same abdominal surgery, two clients both rate their pain 8 on a 0-10 scale. A coworker says one of them, a Black man texting on his phone, "can't really be hurting that much." What should the nurse do?
1. AAsk the provider to change his order to a non-opioid
2. BWait to medicate until he looks visibly uncomfortable
3. CGive him a lower dose in the ordered range than the other client
4. DGive the ordered analgesic based on his own pain rating
Answer and explanation in LearnFree account
Question 14 · Hard
An 8-month-old is brought to the emergency department with a spiral fracture of the femur. The parents say he rolled off the couch. He is not yet crawling or pulling to stand. A skeletal survey is ordered. What should the nurse do?
1. AReport suspected abuse now, without waiting for the survey
2. BAsk the parents directly why they hurt the infant
3. CWait for the skeletal survey result before making a report
4. DTeach the parents about safe sleep and couch safety
Answer and explanation in LearnFree account
Question 15 · Hard
In the emergency department, a 34-year-old woman with a forearm bruise says her partner grabbed and shoved her last night and has threatened to kill her. She says, "I don't want the police involved." She is alert and oriented. Which action is the priority?
1. ADocument that the client claims her partner abused her
2. BCall the police now because a threat to kill was made
3. CAssess her immediate safety and help her make a safety plan
4. DTell her she should leave the relationship today
Answer and explanation in LearnFree account
Question 16 · Easy
In every US state, registered nurses are mandated reporters of suspected:
1. AChild abuse or neglect
2. BAlcohol use by a competent adult
3. CMarijuana use by an adult client
4. DUndocumented immigration status
Answer and explanation in LearnFree account
Question 17 · Medium
Which conflict-resolution strategy is most likely to produce a win-win outcome for both parties?
1. ACollaborating
2. BAccommodating
3. CAvoiding
4. DCompromising
Answer and explanation in LearnFree account
Question 18 · Medium
Two assistive personnel are arguing loudly at the nurses' station about the fairness of their assignments. Which action by the charge nurse is best?
1. AMove one of them to another unit for good
2. BTell them to sort it out between themselves
3. CReport both to the nurse manager right away
4. DMeet with both privately to hear each side
Answer and explanation in LearnFree account
Question 19 · Medium
Which action by a nurse is a breach of client confidentiality?
1. AGiving bedside report with the client's agreement
2. BOpening the chart of a neighbour admitted to another unit
3. CReviewing an assigned client's notes from past admissions
4. DSending records to a receiving facility during a transfer
Answer and explanation in LearnFree account
Question 20 · Medium
A caller says she is a client's sister and asks how he is doing after surgery. The client asked that no information be released. What is the nurse's best response?
1. AHe is doing well and should go home tomorrow.
2. BI'm not able to give out any client information.
3. CI can update you if you give me his date of birth.
4. DThe charge nurse can update you if you call back.
Answer and explanation in LearnFree account
Question 21 · Medium
An 82-year-old client has bruises of different colours on both upper arms. Her son, who is her caregiver, answers every question for her. What should the nurse do first?
1. AConfront the son about the pattern of bruising
2. BWait for the client to disclose abuse before acting
3. CInterview the client privately, away from her son
4. DAsk the son to explain how each bruise happened
Answer and explanation in LearnFree account
Question 22 · Medium
A nurse sees a coworker's public post that says, "Had the most confused old guy in room 12 tonight, LOL." No name is given. What should the nurse do?
1. AReport the post through facility channels
2. BIgnore the post because the client is not named
3. CReply to the post warning others not to share it
4. DSend a screenshot to coworkers to discuss the issue
Answer and explanation in LearnFree account
Question 23 · Medium
A client is found on the floor beside the bed. After caring for the client, which entry belongs in the client's medical record?
1. AA photocopy of the incident report placed in the chart
2. BThe assessment findings and care given after the fall
3. CA statement that understaffing caused the client's fall
4. DIncident report completed and sent to risk management
Answer and explanation in LearnFree account
Question 24 · Medium
A client asks to read his own medical record while he is in the hospital. What is the nurse's best response?
1. AAgree only after his health care provider approves the request
2. BTell him he has that right and arrange it per policy
3. CTell him the record belongs to the hospital and cannot be shown
4. DLet him read the screen while staying silent about its contents
Answer and explanation in LearnFree account
Question 25 · Hard
A man who is experiencing homelessness arrives with chest pressure and sweating. He smells of alcohol. A coworker says, "He just wants a warm bed." BP 156/94 mm Hg, HR 108/min. What should the nurse do first?
1. AHave him wait until he is sober enough to be assessed
2. BAsk security to check whether he has been here before
3. CGive him a meal and a blanket while he waits
4. DObtain a 12-lead ECG per the chest pain protocol
Answer and explanation in LearnFree account

21 more Confidentiality, reporting, quality and equitable care questions

Answer them one by one, keep your score and see your weak topics in Learn. Signed-out visitors try 25 per exam; sign in with Google to see them all.

Study Management of Care

Confidentiality, reporting, quality and equitable care

In a Plan-Do-Study-Act cycle for a unit quality project, the Study step involves:

The main purpose of completing an incident (occurrence) report is to:

A client is told that his HIV test is positive. He says, "Please don't tell anyone, not even the health department." What is the nurse's best response?

A nurse wants to write online about a meaningful shift at work. Which plan follows professional social-media guidance?

Which newly diagnosed condition must the nurse make sure is reported to the local or state health department?

During orientation the nurse educator reviews social-media use. Which statement by a new nurse indicates a need for further teaching?

A male client asks that his husband stay overnight. A coworker says, "Only spouses of the opposite sex count as family here." Visiting policy lets clients choose their own visitors. What should the nurse do?

A medical unit recorded 4 client falls in March over 1,600 patient-days. What is the fall rate per 1,000 patient-days?

Under HIPAA, which disclosure of a client's health information may the nurse make without the client's written authorization?

A quality team is tracking a pressure-injury prevention project. Which measure is an outcome measure?

A well-known local politician is admitted after a car crash. Which person may the nurse allow to review the client's electronic record?

A transgender woman is admitted to a medical unit. Which nursing action best shows unbiased, respectful care?

Day 1 after the same abdominal surgery, two clients both rate their pain 8 on a 0-10 scale. A coworker says one of them, a Black man texting on his phone, "can't really be hurting that much." What should the nurse do?

An 8-month-old is brought to the emergency department with a spiral fracture of the femur. The parents say he rolled off the couch. He is not yet crawling or pulling to stand. A skeletal survey is ordered. What should the nurse do?

In the emergency department, a 34-year-old woman with a forearm bruise says her partner grabbed and shoved her last night and has threatened to kill her. She says, "I don't want the police involved." She is alert and oriented. Which action is the priority?

In every US state, registered nurses are mandated reporters of suspected:

Which conflict-resolution strategy is most likely to produce a win-win outcome for both parties?

Two assistive personnel are arguing loudly at the nurses' station about the fairness of their assignments. Which action by the charge nurse is best?

Which action by a nurse is a breach of client confidentiality?

A caller says she is a client's sister and asks how he is doing after surgery. The client asked that no information be released. What is the nurse's best response?

An 82-year-old client has bruises of different colours on both upper arms. Her son, who is her caregiver, answers every question for her. What should the nurse do first?

A nurse sees a coworker's public post that says, "Had the most confused old guy in room 12 tonight, LOL." No name is given. What should the nurse do?

A client is found on the floor beside the bed. After caring for the client, which entry belongs in the client's medical record?

A client asks to read his own medical record while he is in the hospital. What is the nurse's best response?

A man who is experiencing homelessness arrives with chest pressure and sweating. He smells of alcohol. A coworker says, "He just wants a warm bed." BP 156/94 mm Hg, HR 108/min. What should the nurse do first?