A nurse is caring for a client who understands a prescribed surgical procedure, but cannot read or write. Which of the following actions should the nurse take?

Allow the client to sign the consent with an X.

Contact the client's power of attorney to sign the consent.

Notify the surgical team that the client is unable to sign the consent.

Inform a family member of the need to sign the consent

Answer and Explanation

The Correct Answer is A

Choice A rationale: According to the American Nurses Association (ANA) Code of Ethics, the nurse should respect the client's right to self-determination and autonomy. The nurse should also provide the client with adequate information and ensure that the client understands the risks and benefits of the procedure. If the client is unable to read or write, the nurse should witness the client's mark on the consent form and document it in the medical record.
Choice B rationale: Contacting the client's power of attorney may be necessary in certain situations, but involving a family member directly for consent is generally more immediate and practical.
Choice C rationale: Notifying the surgical team about the client's inability to sign the consent is important, but the more immediate action is to involve a family member in the consent process.
Choice D rationale: This violates the client’s right to autonomy, unless the client requests or authorizes it.

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Correct Answer is C

Explanation

Choice A rationale: Administering morphine for pain control is appropriate and does not require clarification.
Choice B rationale: Notifying the provider when tidaling (fluctuation of fluid in the water seal chamber) ceases is appropriate, as it could indicate a problem with the chest tube.
Choice C rationale: Vigorously stripping the chest tube is an outdated and potentially harmful practice. The nurse should clarify this prescription with the provider.
Choice D rationale: Assisting the client out of bed three times daily is a routine activity and does not require clarification.

A. Digoxin B. Diltiazem C. Magnesium sulfate D. Atropine sulfate

Correct Answer is D

Explanation

Choice A rationale: Digoxin is not typically used for acute management of bradycardia; it is more commonly used for heart failure.
Choice B rationale: Diltiazem is a calcium channel blocker and may further reduce heart rate, making it inappropriate for this situation.
Choice C rationale: Magnesium sulfate is used for certain cardiac arrhythmias but is not the first-line treatment for symptomatic bradycardia.
Choice D rationale: A heart rate of 38/min with symptoms of tremors and feeling faint suggests symptomatic bradycardia. Atropine sulfate is commonly used to increase heart rate in bradycardia.

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A nurse is caring for a client who understands a prescribed surgical procedure, but cannot read or write. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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