A nurse is preparing to insert an indwelling urinary catheter and is verifying the client's express consent for this procedure. Which of the following actions should the nurse take?

Check the medical record for the client's signature on a previous consent form.

Have another nurse co-sign the client's consent.

Obtain verbal consent from the end.

Witness the client's signature on a consent form.

Answer and Explanation

The Correct Answer is D

Choice A Reason:

Checking the medical record for the client's signature on a previous consent form is incorrect. While a previous consent form might exist in the medical records, for certain procedures or situations, specific, current consent for each instance is often necessary. Verifying a previous consent form may not ensure the client's informed consent for the current procedure.

Choice B Reason:

Having another nurse co-sign the client's consent is incorrect. Co-signing a client's consent by another nurse doesn't substitute for the client's own signature and may not adequately verify the client's informed decision and understanding of the procedure.

Choice C Reason:

Obtaining verbal consent from the client is incorrect. While obtaining verbal consent is important, for invasive procedures like catheter insertion, it's essential to have written, witnessed consent to ensure proper documentation and confirmation that the client is fully informed and agrees to the procedure.

Choice D Reason:

Witnessing the client's signature on a consent form is correct. Express consent for medical procedures typically involves the client signing a consent form after being adequately informed about the procedure, its potential risks, benefits, and alternatives. Witnessing the client's signature on a consent form ensures that the client has provided informed consent for the specific procedure.

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Correct Answer is C

Explanation

Choice A Reason:

Verifying the bilirubin level of the tube contents is incorrect. Measuring bilirubin levels in the tube contents is not a standard or reliable method for confirming tube placement. It's not an established or recommended technique for this purpose.

Choice B Reason:

Auscultating for air insufflation is incorrect. Auscultation for air insufflation involves injecting air into the tube and listening for bubbling sounds over the stomach area. While this method is commonly used, it can sometimes yield inconsistent or inconclusive results, especially in patients with certain conditions or situations where air movement might not be detectable.

Choice C Reason:

Request a chest x-ray is correct. Obtaining a chest x-ray is the most reliable method to confirm the placement of a feeding tube, especially when the tube is newly inserted or if there are any doubts about its location. A chest x-ray can accurately visualize the position of the tube within the gastrointestinal tract, ensuring it is in the intended location before any feedings or medications are administered.

Choice D Reason:

Checking the pH level of gastric contents is incorrect. Measuring the pH level of aspirated gastric contents can provide information about the acidity of the fluid, indicating gastric placement (pH below 5) in most cases. However, the pH can be influenced by various factors like medications, enteral feeding solutions, or certain medical conditions, making it less reliable than a chest x-ray for definitive confirmation of tube placement.

A. Decrease the volume on the hearing aid. B. Clean the hearing aid with isopropyl alcohol. C. Turn the hearing aid off for 5 min. D. Soak the hearing aid in warm water.

Correct Answer is A

Explanation

Choice A Reason:

Decreasing the volume on the hearing aid is correct. Whistling or feedback in a hearing aid can often occur due to excessive volume. Lowering the volume can help eliminate or reduce the whistling sound without disrupting the functioning of the hearing aid.

Choice B Reason:

Cleaning the hearing aid with isopropyl alcohol is incorrect. While cleaning the hearing aid is essential for maintenance, using isopropyl alcohol might not resolve the issue of whistling. It's more for general hygiene and cleanliness of the device.

Choice C Reason:

Turning the hearing aid off for 5 minutes is incorrect. Turning off the hearing aid might not address the specific issue of whistling. Additionally, it could inconvenience the client's ability to hear during that time.

Choice D Reason:

Soaking the hearing aid in warm water is incorrect. Soaking a hearing aid in water is not a recommended method, as it could damage the device and its electronic components. Water exposure might also worsen the issue instead of resolving it.

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A nurse is preparing to insert an indwelling urinary catheter and is verifying the client's express consent for this procedure. Which of the following actions should the nurse take?

Nursing Test Bank

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Correct Answer is C

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Correct Answer is A

Explanation

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