A nurse is caring for a client who is scheduled for a mastectomy. The client tells the nurse. "I'm not sure I want to have a mastectomy." Which of the following statements should the nurse make?
"I can give you a list of other people who had the same procedure."
“can give you additional information about the procedure."
“You will be cancer-free if you have the procedure
“You should get a second opinion regarding the procedure."
The Correct Answer is B
Choice A Reason:
"I can give you a list of other people who had the same procedure." - This response might not address the client's concerns and could potentially violate privacy and confidentiality.
Choice B Reason:
"I can give you additional information about the procedure." Response B is an appropriate and supportive response. The client is expressing uncertainty about the mastectomy, so offering more information about the procedure can help the client make an informed decision. Providing accurate and detailed information allows the client to better understand their options and the potential benefits and risks of the procedure.
Choice C Reason:
"You will be cancer-free if you have the procedure." - Making a guarantee of being cancer-free after the procedure might be misleading and overly optimistic. While a mastectomy can treat cancer in some cases, it's important to provide realistic information.
Choice D Reason:
"You should get a second opinion regarding the procedure." - While seeking a second opinion can be valuable, this response might not directly address the client's immediate concerns about the procedure. Providing information first and then discussing the option of a second opinion might be a more balanced approach.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason:
Obtaining consent for surgery is the correct answer. Obtaining informed consent for surgery is a critical and ethical step to ensure the client's rights are respected and that necessary medical interventions can be performed. However, in cases where the client is unable to provide consent due to their level of intoxication, the nurse should follow established protocols for obtaining consent from a legal guardian or
Choice B reason:
Insert an NG tube is incorrect. Inserting a nasogastric (NG) tube might be a necessary step in preparing a client for surgery in certain cases, but it is not the top priority in this situation. Obtaining consent for surgery takes precedence.
Choice C reason:
Applying ant embolic stockings is incorrect. Applying ant embolic stockings, also known as compression stockings, is an important measure to prevent blood clots (deep vein thrombosis) during and after surgery. However, obtaining consent for surgery is more urgent in an emergency situation.
Choice D reason:
Inserting an indwelling urinary catheter is incorrect. Inserting a urinary catheter might be necessary to monitor the client's urinary output during surgery, but obtaining consent for surgery is the priority action.
Correct Answer is B
Explanation
Choice A Reason:
"This finding may indicate possible medication toxicity." - The red-orange colour change in bodily fluids from rifampin is not indicative of medication toxicity.
Choice B Reason:
"This is an expected adverse effect of this medication." Rifampin is an antibiotic commonly used to treat tuberculosis. One of the well-known side effects of rifampin is the discoloration of bodily fluids, including saliva, tears, sweat, and urine, to a red-orange colour. This is a harmless and expected adverse effect of the medication and is not a sign of toxicity or other serious concerns.
Choice C Reason:
"Your provider will prescribe a different medication regimen." - There is no need to change the medication regimen based solely on the colour change of bodily fluids. This is an expected effect of rifampin.
Choice D Reason:
"You will need to increase your fluid intake to resolve this problem." - Increasing fluid intake will not resolve the colour change caused by rifampin. The client should be educated about the benign nature of the side effects instead.
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