A nurse is caring for a client who is scheduled for surgery. While the nurse is witnessing the client's signature, the client states, "I trust my doctor, but I don't understand what is meant by resecting my intestines." Which of the following actions should the nurse take?
Notify the provider.
Describe the surgery to the client.
Provide brochures about the procedure.
Complete an incident report.
The Correct Answer is A
Choice A reason:
The client has expressed a lack of understanding about the procedure, which indicates that they may not have received sufficient information or clarification. It is important to notify the provider so they can ensure the client fully understands the procedure before giving informed consent.
Choice B reason:
The nurse should provide basic information and answer questions within their scope, but detailed explanations about the procedure are best provided by the provider who is performing the surgery.
Choice C reason:
While brochures can be helpful, they do not replace the need for direct, clear communication with the healthcare provider about the specific details of the surgery.
Choice D reason:
An incident report is not necessary in this context as the situation is related to informed consent and not an error or safety issue.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason:
The cephalic vein on the back of the right hand is incorrect because it might still involve the same arm as the mastectomy site, and it is important to avoid this side.
Choice B reason:
The radial vein on the left wrist is incorrect because it is not on the opposite side of the mastectomy and could increase the risk of lymphedema.
Choice C reason:
The basilic vein in the right antecubital fossa is the appropriate answer. When inserting an IV catheter for a client who has undergone a right mastectomy, it is generally advisable to avoid the arm on the same side as the mastectomy due to the risk of lymphedema and impaired lymphatic drainage. The basilic vein in the right antecubital fossa (the inner bend of the right elbow) would be a suitable choice in this case, as it is on the opposite side of the mastectomy.
Choice D reason:
The cephalic vein in the left distal forearm is on the same side as the mastectomy and should be avoided to reduce the risk of complications.
Correct Answer is D
Explanation
Choice A reason:
Soaking feet in warm water daily is not recommended for individuals with diabetes, as it can increase the risk of skin maceration and infection. People with diabetes should be cautious about foot care practices that involve prolonged moisture exposure.
Choice B reason:
Placing an oval corn pad over the toes with corn and removing it weekly may not be the best approach, as it can increase pressure on the area and potentially cause further skin irritation.
Choice C reason:
Using over-the-counter liquid medication to remove corns is not recommended for individuals with diabetes, as it can cause skin irritation, burns, or infection. It's important for individuals with diabetes to seek professional guidance for proper foot care.
Choice D reason:
"I can apply lotion to soften calluses as long as I don't put lotion between my toes." This is the correct statement. This statement indicates an understanding of proper care for corns and calluses. Applying lotion to soften calluses can help reduce discomfort, but it's important to avoid putting lotion between the toes to prevent excess moisture build-up that could lead to skin breakdown or infection.
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