A nurse in the emergency department is preparing to care for a client who arrived via ambulance. The client is disoriented and has a cardiac arrhythmia. Which of the following actions should the nurse take?

Notify risk management before initiating treatment.

Proceed with treatment without obtaining written consent.

Contact the client's next of kin to obtain consent for treatment.

Have the client sign a consent for treatment.

Answer and Explanation

The Correct Answer is B

A.   Notifying risk management before initiating treatment is not necessary in this emergent situation; patient care should take precedence.
B.   In emergent situations where a patient lacks decision-making capacity and requires
immediate treatment to prevent harm, consent for treatment can be assumed based on the principle of implied consent.
C.   Contacting the client's next of kin for consent might delay necessary treatment for the disoriented and arrhythmic client, which could be harmful.
D.   Having the client sign a consent for treatment might not be feasible or appropriate if the client is disoriented and lacks decision-making capacity in an emergency situation.

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Correct Answer is B

Explanation

A. Management of Type 1 diabetes with an insulin pump usually involves ongoing monitoring and adjustments but may not necessarily warrant an immediate interdisciplinary conference.
B. This client has a notable risk for pressure ulcers due to the albumin level, necessitating an interdisciplinary approach to prevent or manage these ulcers.
C. While monitoring heparin therapy is crucial, an aPTT of 34 seconds is within the therapeutic range and may not require an urgent interdisciplinary conference.
D. Orthostatic hypotension being managed with IV fluids may need ongoing assessment, but it may not warrant an immediate interdisciplinary conference.

A. Instruct the AP to request assistance when unsure about a task. B. Demonstrate the proper client transfer technique for the AP. C. Help the AP assist the client with the transfer. D. Refer the AP to the facility procedure manual.

Correct Answer is C

Explanation

A. Instructing the AP to request assistance when unsure about a task is important for future situations, but it does not immediately address the current incorrect transfer, which could pose a risk to the client.
B. Demonstrating the proper client transfer technique for the AP directly addresses the immediate issue, ensuring the client is safely transferred and the AP learns the correct method through observation and practice.
C. Helping the AP assist the client with the transfer ensures the client's safety in the moment, but it does not provide the AP with the knowledge or skills needed to perform the task correctly in the future.
D. Referring the AP to the facility procedure manual is useful for long-term learning, but it does not provide the immediate guidance needed to correct the current unsafe transfer.

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A nurse in the emergency department is preparing to care for a client who arrived via ambulance. The client is disoriented and has a cardiac arrhythmia. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse working on a medical-surgical unit is managing the care of four clients. The nurse should schedule an interdisciplinary conference for which of the following clients?

Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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