An unresponsive male victim of a diving accident is brought to the emergency department where it is determined that immediate surgery is required to save his life.
The client is accompanied by a close friend, but no family members are available.
Which action should the nurse take first?
Carry on with surgical preparation of the client without a signed informed consent.
Ask the man's friend to sign the informed consent since the client is unresponsive.
Notify the unit manager that an emergency court order is needed to allow surgery.
Continue to provide life support until a thorough search for a guardian is completed.
The Correct Answer is A
The correct answer is choice a. Carry on with surgical preparation of the client without a signed informed consent.
Choice A rationale:
In emergency situations where immediate surgery is required to save a patient’s life and no family members are available, the doctrine of presumed consent applies. This means that healthcare providers can proceed with necessary treatment without a signed informed consent to prevent serious harm or death.
Choice B rationale:
Asking the man’s friend to sign the informed consent is not appropriate because friends are not legally authorized to provide consent for medical procedures unless they have legal documentation proving their authority.
Choice C rationale:
Notifying the unit manager for an emergency court order would delay the necessary surgery, which could be detrimental to the patient’s health. In emergencies, immediate action is required, and waiting for a court order is not feasible.
Choice D rationale:
Continuing to provide life support while searching for a guardian would also delay the necessary surgery. In life-threatening situations, immediate surgical intervention is prioritized over finding a legal guardian.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice D rationale:
Taking zolpidem before bedtime is the correct information to include in the education. Zolpidem is a medication used for the short-term treatment of insomnia and should be taken immediately before going to bed to facilitate sleep onset.
Choice A rationale:
Crushing zolpidem to increase absorption is not recommended. The medication should be taken whole and not crushed or chewed.
Choice B rationale:
Storing zolpidem at room temperature is correct. Like many medications, zolpidem should be stored at a controlled room temperature, away from moisture and heat.
Choice C rationale:
Administering zolpidem with a meal is not necessary and may delay the onset of its effects. It is typically taken on an empty stomach for faster absorption.
Correct Answer is ["A","B","C","E"]
Explanation
Choice A rationale:
The client’s presentation of a noticeable facial droop and garbled speech are classic symptoms of a stroke. These symptoms indicate that the brain is not receiving enough oxygen, which can lead to permanent damage if not treated immediately. Therefore, this client requires immediate health interventions.
Choice B rationale:
This choice is identical to Choice A. The client’s noticeable facial droop and garbled speech are indicative of a stroke and require immediate attention.
Choice C rationale:
This choice is also identical to Choices A and B. The client’s symptoms are indicative of a stroke, which is a medical emergency that requires immediate intervention.
Choice D rationale:
While the change in the client’s speech after having a few drinks at a restaurant could be due to alcohol consumption, it could also be a symptom of a stroke, especially when combined with the facial droop. However, this choice does not directly indicate the need for immediate health interventions as it lacks the specificity of the symptoms compared to Choices A, B, and C.
Choice E rationale:
The time of arrival and mode of transportation do not directly indicate the need for immediate health interventions. However, the mention of facial drooping and garbled speech upon arrival at the emergency department reinforces the urgency of the situation, as these are classic symptoms of a stroke. In conclusion, Choices A, B, C, and E all highlight data that indicate the client is in need of immediate health interventions due to potential stroke symptoms. It’s important to note that strokes require immediate medical attention to minimize brain damage and potential complications. Normal ranges for lab parameters would not apply in this scenario as it’s based on clinical observations rather than laboratory findings.
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