A nurse is witnessing the informed consent for a client who is scheduled for surgery. Which of the following actions should the nurse take?
Ask the client if they understand the procedure.
Describe the procedure to the client.
Inform the client about alternative treatments options.
Explain the risks of the procedure to the client.
The Correct Answer is A
A. Ask the client if they understand the procedure. The nurse’s role in informed consent is to confirm that the client understands the procedure and voluntarily agrees to it. If the client has questions or does not understand, the nurse should notify the provider for further explanation.
B. Describe the procedure to the client. It is the provider’s responsibility to explain the procedure in detail, including what it entails. The nurse should not provide this explanation.
C. Inform the client about alternative treatment options. The provider must discuss alternative treatment options, not the nurse. The nurse can ensure that this discussion has occurred but does not provide the alternatives.
D. Explain the risks of the procedure to the client. The provider is responsible for explaining the risks, benefits, and expected outcomes of the procedure. The nurse’s role is to witness the consent and ensure the client understands.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "Although this is your first incident, we will have to terminate your employment." This response is punitive and does not align with a just culture, which seeks to identify the cause of errors rather than immediately disciplining staff.
B. "We will review the incident report to determine the cause of the missed medication." This aligns with just culture principles by focusing on finding the root cause (e.g., workload issues, system inefficiencies) rather than blaming the nurse.
C. "I will need to report this incident to the state board of nursing." A missed medication dose that caused no harm typically does not require reporting to the state board. Just culture focuses on improving processes rather than unnecessary punishment.
D. "The facility's legal team will be contacting you to discuss the incident." Involving legal action for a minor, non-harmful event is excessive and contradicts just culture, which emphasizes education, accountability, and system improvements over legal consequences.
Correct Answer is A
Explanation
A. High-pitched wheezing Wheezing indicates airway constriction, which is a sign of anaphylaxis, a life-threatening allergic reaction. This requires immediate intervention (e.g., stopping the medication, administering epinephrine, and providing oxygen).
B. Urticaria over the entire body While urticaria (hives) is a sign of an allergic reaction, it is not as urgent as airway compromise. It should still be reported but does not take immediate priority over wheezing.
C. Pruritis of the face Facial itching is a mild allergic reaction but does not indicate imminent airway compromise like wheezing does.
D. Rhinitis with clear discharge Nasal congestion or a runny nose can be a mild allergic reaction but is not an emergency.
Priority action: Apply the ABC (Airway, Breathing, Circulation) framework, which prioritizes airway compromise (wheezing) over skin-related allergic reactions.
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