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Exhibits Here

The nurse is preparing the client for surgery. Which of the following actions should the nurse take? Select all that apply.

Obtain a complete blood count.

Prepare the client for insertion of an 18-gauge peripheral IV prior to surgery.

Administer Rh, D immune globulin prior to surgery.

Explain the surgical procedure to the client.

Verify consent form is signed by the client.

Assist with the administration of AB-positive blood products if needed.

Remind the client to be NPO prior to surgery.

Answer and Explanation

Correct Answer : A,B,C,E,G

Based on the given information, the nurse should take the following actions in preparation for surgery:

Obtain a complete blood count: This is important to assess the client's hemoglobin, hematocrit, and other blood parameters before surgery.
Prepare the client for insertion of an 18-gauge peripheral IV prior to surgery: Adequate IV access is necessary for the administration of fluids and medications during and after surgery.
Administer Rh, D immune globulin prior to surgery: This action is indicated if the client is Rh-negative and there is a possibility of fetal-maternal blood mixing during the termination of pregnancy. Rh, D immune globulin is given to prevent sensitization to

Rh-positive blood.

Verify consent form is signed by the client: Ensuring that the client has provided informed consent is essential before proceeding with any surgical intervention.
Remind the client to be NPO (nothing by mouth) prior to surgery: It is important for the client to have an empty stomach to reduce the risk of aspiration during anesthesia.

The following actions are not indicated based on the given information:

Explaining the surgical procedure to the client: Although it is important for the client to have an understanding of the procedure, this is typically done by the surgeon rather than the nurse.
Assisting with administration of AB positive blood products if needed: There is no indication of the need for blood products based on the information provided. Blood product administration would be determined based on the client's specific condition and surgical requirements.

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Correct Answer is A

Explanation

When providing a change-of-shift report, it is important to do so in a private and secure area away from public spaces. Sharing client information outside the client's room helps maintain confidentiality and prevents unauthorized individuals from overhearing sensitive information. Discussions about a client's prognosis should be limited to the appropriate healthcare professionals involved in the client's care. Sharing this information with an assistive personnel who is not directly involved in the client's care breaches confidentiality.

Displaying a client's diagnosis on a message board in a public area breaches confidentiality. It is essential to respect and protect a client's privacy by avoiding the unnecessary disclosure of sensitive information.

Proper disposal of documents containing client information is crucial to maintain confidentiality. Discarding worksheets with client information in a wastebasket without ensuring they are securely destroyed or shredded poses a risk of unauthorized access to sensitive information.

A. Encourage the client to be assertive. B. Limit the client's social interactions. C. Maintain a verbal no-harm contract with the client. D. Assume responsibility for making the client's decisions.

Correct Answer is A

Explanation

Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, leading to submissive and clinging behavior. When providing discharge teaching to the caregiver of a client with dependent personality disorder, it is important to promote the client's independence and self-empowerment. Encouraging the client to be assertive is an appropriate instruction because it promotes the development of self-advocacy skills and assertiveness, which can help the client gain confidence and reduce dependency on others.

limiting the client's social interactions in (option B) is incorrect because it, would not be an appropriate instruction. Restricting social interactions may further reinforce the client's dependency and hinder their ability to develop social skills and relationships.

maintaining a verbal no-harm contract with the client in (option C) is incorrect because it, is not specifically related to the management of dependent personality disorder. No-harm contracts are more commonly used in the context of managing self-harm or suicidal ideation, which may or may not be present in individuals with dependent personality disorder.

assuming responsibility for making the client's decisions in (option D) is incorrect because it, would further enable the client's dependency and undermine their autonomy. It is important to encourage the client to make their own decisions and take responsibility for their actions, within their capabilities.

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Exhibits Here The nurse is preparing the client for surgery. Which of the following actions should the nurse take? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing client confidentiality with other staff members. The nurse should identify that which of the following actions is an example of protecting client confidentiality?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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Exhibits Here

The nurse is preparing the client for surgery. Which of the following actions should the nurse take? Select all that apply.