A nurse is caring for a client who is scheduled for a procedure. Which of the following actions should the nurse take during the time-out?
(Select All that Apply.)
Ask the client to read their identification bracelet.
Ask the client to point to the surgical site.
Use two acceptable client identifiers.
Verify that the surgical site has been marked.
Ask the client to state the surgery being performed.
Correct Answer : C
A. Asking the client to read their identification bracelet can be additional verification steps, but it is not standard practice for all institutions
B. To point to the surgical site can be additional verification steps, but it is not standard practice for all institutions.
C. Using two acceptable client identifiers, such as the client's name and date of birth, to confirm the patient's identity.
D. It is important to verify that the surgical site has been marked, which is a critical step in preventing wrong-site surgery.
E. Asking the client to state the surgery being performed is a good practice as it involves the patient in their care and serves as a final verification of the correct procedure.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C"]
Explanation
A. Asking the client to read their identification bracelet can be additional verification steps, but it is not standard practice for all institutions
B. To point to the surgical site can be additional verification steps, but it is not standard practice for all institutions.
C. Using two acceptable client identifiers, such as the client's name and date of birth, to confirm the patient's identity.
D. It is important to verify that the surgical site has been marked, which is a critical step in preventing wrong-site surgery.
E. Asking the client to state the surgery being performed is a good practice as it involves the patient in their care and serves as a final verification of the correct procedure.
Correct Answer is D
Explanation
A. While asking appropriate questions demonstrates that the partner is engaged and seeking understanding, it alone does not indicate that they are ready to perform the procedure independently.
B. Being able to verbalize all steps in the procedure shows that the partner has knowledge and understanding of the process. However, verbalizing alone does not confirm that they can perform the procedure accurately and safely. Practical skills and hands-on competence are crucial for readiness.
C. Attending a class provides important theoretical knowledge and information about tracheostomy care. However, attending a class by itself does not guarantee that the partner has developed the necessary skills to perform suctioning independently.
D. The ability to perform the procedure independently indicates that the partner has acquired the necessary skills and confidence to carry out suctioning safely and effectively. It shows practical proficiency, which is essential for readiness for discharge. The partner’s ability to perform suctioning without assistance demonstrates that they can handle the procedure in real-life situations.
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