A nurse is preparing to obtain informed consent from a client who speaks a different language than the nurse and is scheduled for surgery.
Which of the following actions should the nurse take?
Have the client nod to indicate understanding.
Recommend an interpreter who is the same gender as the client.
Use medical terminology when explaining the procedure.
Address all questions to the interpreter.
The Correct Answer is B
This statement indicates that the nurse should take steps to ensure effective communication with the client by recommending an interpreter who is the same gender as the client.
This can help to facilitate understanding and comfort during the informed consent process.

Choice A is wrong because nodding alone is not sufficient to indicate understanding.
Choice C is wrong because using medical terminology can be confusing and may not facilitate understanding.
Choice D is wrong because questions should be addressed directly to the client, with the interpreter facilitating communication.
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Related Questions
Correct Answer is D
Explanation
The first two actions the nurse should take are to obtain a sputum culture and a chest X-ray.
These tests can help diagnose the cause of the client’s symptoms and guide treatment.
Choice A is wrong because administering antibiotics and bronchodilators should only be done after a diagnosis has been made.
Choice B is wrong because airborne precautions and isolation may not be necessary depending on the cause of the client’s symptoms.
Choice C is wrong because cough suppressants and antihistamines may not be appropriate treatments depending on the cause of the client’s symptoms.
Correct Answer is B
Explanation
A. Change the tubing set every 72 hr:Continuous enteral feeding tubing sets should generally be changed every 24 hours to reduce the risk of bacterial contamination. Changing every 72 hours is too long and increases infection risk.
B. Aspirate residual volume every 4 hr:Aspiration of residual volume every 4 hours is standard practice when providing continuous enteral feedings. This ensures the client is tolerating the feedings and helps prevent aspiration or overfeeding. Large residual volumes may indicate poor gastric emptying.
C. Flush the tubing with 10 mL of water every 2 hr:The tubing should be flushed with 30 mL of water every 4-6 hours (depending on protocol), not just 10 mL, to maintain tube patency and prevent clogging.
D. Heat the formula to 40.5° C (105° F):Formula should not be heated to such a high temperature. It should be administered at room temperature to avoid discomfort and potential damage to the gastrointestinal tract.
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