NCLEX Question Rationale

[metal_m0nk, BSN, RN]

I'm getting a jump on NCLEX questions using the NCLEX-RN 3500 - Institutional Version software and there is a question that seems odd to me:

A female client who recently had a colostomy expresses concerns about her sexual relationship with her husband. Which of the following interventions should the nurse implement?

1. Discuss the client's concern with the husband.

2. Refer the client to a psychiatrist.

3. Invite a client with a similar experience to speak with the client.

4. Refer the client to a sex therapist.

The correct answer is "3. Invite a client with a similar experience to speak with the client."

The rationale states: "Having someone who has had a similar surgery and concerns speak to the client would be beneficial. The client is coping normally and doesn't need professional help. Discussing the concerns with the client's husband doesn't address the client's needs. In fact, the client may feel that the nurse violated confidentiality."

My question is, wouldn't inviting a client with a similar experience to speak with the client also be a violation of confidentiality??

[Hygiene Queen]

No. The key word is "inviting". You are seeking permission in the process.

You ask a similar patient if they would like to talk about it with someone "going through the same thing" and then you ask the original patient if they would like to talk to this person.

If both agree, there is no violation.

This is more of a "psych" question than anything else. The patient's feelings should be validated and she needs to be allowed to express herself.

If she can be allowed interaction with someone in the same boat, she sees she is not alone in her concerns.

[metal_m0nk, BSN, RN]

No. The key word is "inviting". You are seeking permission in the process.

You ask a similar patient if they would like to talk about it with someone "going through the same thing" and then you ask the original patient if they would like to talk to this person.

If both agree, there is no violation.

This is more of a "psych" question than anything else. The patient's feelings should be validated and she needs to be allowed to express herself.

If she can be allowed interaction with someone in the same boat, she sees she is not alone in her concerns.

I see...

The thinking behind my question was that, in the invitation wouldn't the nurse be disclosing personal procedural information about the anxious client to a total stranger?

But now that I see the invitation "process" I see how the nurse can arrange the conversation without breaking confidentiality.

Thanks.

[lkwashington]

Think this way the other answers are passing the buck. Inviting someone else is doing something about. The nurse is showing initiative and implementing a plan of action. Just a thought.

[metal_m0nk, BSN, RN]

Think this way the other answers are passing the buck. Inviting someone else is doing something about. The nurse is showing initiative and implementing a plan of action. Just a thought.

In order of importance/necessity, I would imagine that patient confidentiality would come before general (not life saving) initiative, wouldn't it?

[DolceVita, ADN, BSN, RN]

We had this same question on an exam in class. Many people thought the same as you and chose other options. When doing these questions you need to develop a little voice that says "and how are you excluding this as the correct answer". I swear I hear my instructors voice as I take exams.

Specifically for this question most people thought exactly as you did (privacy issues). Our instructor said they were over thinking. Gotta love nursing exams!

[metal_m0nk, BSN, RN]

We had this same question on an exam in class. Many people thought the same as you and chose other options. When doing these questions you need to develop a little voice that says "and how are you excluding this as the correct answer". I swear I hear my instructors voice as I take exams.

Specifically for this question most people thought exactly as you did (privacy issues). Our instructor said they were over thinking. Gotta love nursing exams!

Yeah, referring to a psych professional seems like the simplest (not overthinking) answer. My error (logically speaking) seemed to be in not overthinking - that is, not going so far as to devise a strategy for enlisting another patient without compromising confidentiality.

The little voice said that enlisting the assistance of another patient (at face value) was a potential confidentiality breech.

[itsmejuli]

That's right, stop over thinking the questions and answers. Throw out the obviously wrong answers and don't try to rationalize them into being correct.

The correct answer to the question you posted is related to offering the patient a support group.

[lkwashington]

In order of importance/necessity, I would imagine that patient confidentiality would come before general (not life saving) initiative, wouldn't it?

Please let me make an correction. By me saying passing the buck I am referring to letting another health professional to implement the situation. We are talking about NCLEX questions. Dont forget dealing with NCLEX exam everything is perfect. But we all know that is not so in the real world. By the nurse discussing with the husband. The husband would take initiative to talk to his wife (passing the buck). The pyschiatrist and sex therapist to deal with the patient (passing the buck). Group therapy with patients talk with each other and have some of the same problems is a good idea. They all can relate. The nurse finds someone who can relate and have the same Medical Diagnose is a great idea is a positive therapy for both parties. I hope I better explain myself. The nurse do not pass the buck, the nurse deals with to best of her ability even she/he has to ask her resource nurse. Like I said before when taking the NCLEX everything is perfect, the nurse has everything she needs such as staffing, equipment, materials, and etc.

[metal_m0nk, BSN, RN]

Please let me make an correction. By me saying passing the buck I am referring to letting another health professional to implement the situation. We are talking about NCLEX questions. Dont forget dealing with NCLEX exam everything is perfect. But we all know that is not so in the real world. By the nurse discussing with the husband. The husband would take initiative to talk to his wife (passing the buck). The pyschiatrist and sex therapist to deal with the patient (passing the buck). Group therapy with patients talk with each other and have some of the same problems is a good idea. They all can relate. The nurse finds someone who can relate and have the same Medical Diagnose is a great idea is a positive therapy for both parties. I hope I better explain myself. The nurse do not pass the buck, the nurse deals with to best of her ability even she/he has to ask her resource nurse. Like I said before when taking the NCLEX everything is perfect, the nurse has everything she needs such as staffing, equipment, materials, and etc.

Gotcha :)

Thank you!

I'm glad to be getting some early insight.

Much appreciated, all.

[caliotter3]

Sometimes no matter how loudly your little voice speaks to you, it is not saying the same thing the little voice says to the person writing the NCLEX question. That is why they say the NCLEX is unpredictable.

[slasher]

This is where I have trouble. The question doesn't state that the nurse will ask the patient in need for permission and then invite someone who is going through the same thing. It simply states, 'invite a client with similar experience..... Which means inviting the client to speak with 'troubled' client is violating confidentiality. Many nursing questions are BS. I'm not inviting anyone anywhere. The nurse would have to get permission from her patient..thats priority numero uno. Not, invite and then assume 'it's all good'.