A nurse is reinforcing teaching with a newly licensed nurse about informed consent. Which of the following statements should the nurse make?
"The client can revoke consent even after the procedure has begun."
"The nurse is responsible for obtaining informed consent.”
"Consent must be obtained from a family member if a client has a mental illness."
"The charge nurse will explain the risks of the procedure to the client.”
The Correct Answer is A
Rationale:
A. "The client can revoke consent even after the procedure has begun.": Clients have the legal right to withdraw consent at any time, including during a procedure. Respecting this autonomy is essential, and healthcare providers must stop the procedure if the client revokes consent.
B. "The nurse is responsible for obtaining informed consent.": Obtaining informed consent is the responsibility of the provider performing the procedure, who must ensure the client understands the risks, benefits, and alternatives. Nurses typically witness and verify the signature but do not obtain consent.
C. "Consent must be obtained from a family member if a client has a mental illness.": Consent depends on the client’s decision-making capacity, not solely on the presence of mental illness. If the client is competent, they can provide consent; if not, a legally authorized representative may be involved.
D. "The charge nurse will explain the risks of the procedure to the client.": Explaining procedure risks is the responsibility of the healthcare provider performing the procedure, not the charge nurse. This ensures that the explanation is accurate and comprehensive.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Milk: Milk does not interfere with fecal occult blood testing and does not contain substances that cause false-positive results. It can be safely consumed prior to the test without affecting the accuracy of the results.
B. Whole wheat bread: Whole wheat bread is high in fiber, which is actually beneficial when preparing for a fecal occult blood test. It helps promote regular bowel movements but does not lead to false-positive results.
C. Red meat: Red meat contains heme, a form of animal blood, which can cause false-positive results on guaiac-based fecal occult blood tests. Avoiding red meat for at least 3 days prior to the test helps reduce the risk of inaccurate results.
D. Almonds: Almonds and other nuts do not contain components that interfere with fecal occult blood testing. They are not known to cause false-positive or false-negative results and are safe to consume before the test.
Correct Answer is ["A","B","C","E"]
Explanation
Rationale:
• Orientation: The client was previously disoriented to time and place, thinking it was 1975 and they were at home. On Day 2, they are alert and fully oriented. This improvement shows enhanced neurological and cognitive status.
• Blood pressure: On Day 1, the client’s BP was 88/50 mm Hg, which indicated hypotension. By Day 2, the BP improved to 132/86 mm Hg. This indicates stabilization of cardiovascular function and better perfusion.
• Temperature: The fever rose to 39.1°C on Day 1 but decreased to 37.7°C on Day 2. This drop suggests the client is responding to treatment and the infectious process is being controlled.
• Hallucinations: On Day 1, the client reported spiders crawling on them, indicating delirium. On Day 2, they deny hallucinations. This improvement shows resolving infection or neuroinflammation.
• WBC count: The WBC count of 14,000/mm³ remains elevated above the normal range and was only assessed on Day 1. Without follow-up labs, it does not indicate improvement.
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