A nurse in a mental health clinic receives a request from a client who is undergoing psychotherapy to obtain a copy of the therapist’s notes.

The correct answer is choice D. The nurse should determine if the client’s health care surrogate is aware of the risks and benefits of the procedure. A health care surrogate is a person who is authorized to make health care decisions for a client who is unable to do so. The nurse has a legal and ethical responsibility to ensure that the client’s surrogate has given informed consent for the surgery, which means that they have received adequate information about the procedure, its purpose, its risks, its benefits, and its alternatives.

Choice A is wrong because sending the unsigned informed consent form to the facility’s risk manager does not ensure that the client’s surrogate has given informed consent. The risk manager is not involved in the consent process and cannot authorize the surgery without the surrogate’s consent.

Choice B is wrong because ensuring that the client’s family supports the provider’s decision for surgery is not the same as obtaining informed consent from the surrogate.

The family may have different opinions or preferences than the surrogate, and the surrogate may not agree with the provider’s decision. The nurse should respect the surrogate’s autonomy and authority to make decisions for the client.

Choice C is wrong because determining if the procedure is medically necessary for the client is not the nurse’s role.

The provider is responsible for determining the medical necessity of the surgery and explaining it to the surrogate. The nurse should not question or interfere with the provider’s judgment unless there is evidence of negligence or malpractice.

Choice A reason:

Substitute tobacco use with an electronic cigarette Electronic cigarette, also known as e-cigarettes or vapes, are not recommended as a primary treatment for nicotine withdrawal. While they may be considered less harmful than traditional tobacco products, their long-term safety and effectiveness in helping individuals quit smoking are still a subject of debate and research. It is generally better to opt for proven nicotine replacement therapies, such as nicotine gum, patches, lozenges, or other medications approved by healthcare providers for smoking cessation.

Choice B reason:

Limitin use of nicotine gum to 6 months is the correct choice. When discussing treatment options with a client experiencing nicotine withdrawal, the nurse should include the information that the use of nicotine gum should be limited to 6 months. Nicotine gum is a form of nicotine replacement therapy (NRT) used to help individuals quit smoking by reducing withdrawal symptoms and cravings.

However, prolonged use of nicotine gum can lead to its own dependence on nicotine, which is counterproductive to the goal of quitting smoking altogether. The use of NRT is typically recommended for a limited duration, and the goal is to gradually reduce the dosage over time until the individual can comfortably quit nicotine use altogether.

Choice C reason:

Using progressively larger nicotine patches Using progressively larger nicotine patches is not a recommended approach for nicotine withdrawal. Nicotine patches are available in different strengths, and the appropriate dosage should be determined based on the individual's smoking history and nicotine dependence. Starting with the appropriate strength and gradually reducing the dosage over time is the preferred approach to help clients quit smoking.

Choice D reason:

Using up to 40 nicotine lozenges per day the use of nicotine lozenges should be guided by the instructions provided with the product or as prescribed by a healthcare provider. It is not advisable to exceed the recommended dosage. Using excessive amounts of nicotine lozenges or any other NRT product can lead to nicotine toxicity and other adverse effects.