Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who understands a prescribed surgical procedure, but cannot read or write. Which of the following actions should the nurse take?
A. Contact the client's power of attorney to sign the consent.
B. Inform a family member of the need to sign the consent.
C. Notify the surgical team that the client is unable to sign the consent.
D. Allow the client to sign the consent with an X
Allow the client to sign the consent with an X. The client has the right to give informed consent if they understand the procedure and its risks and benefits, even if they cannot read or write. The nurse should witness and document the client's signature with an X and verify their identity and understanding. The other options are not appropriate because they violate the client's autonomy and dignity.
This question is an excerpt from Nurse Dive's nursing test bank - ATI RN adult medical surgical 2019 with NGN - Proctored Exam 3. Take the full exam now
Full Explanation
Allow the client to sign the consent with an X. The client has the right to give informed consent if they understand the procedure and its risks and benefits, even if they cannot read or write. The nurse should witness and document the client's signature with an X and verify their identity and understanding. The other options are not appropriate because they violate the client's autonomy and dignity.
Similar Questions
A nurse is assessing a client who is preoperative and reports an allergy to bananas. The nurse should recognize that the client is at risk for an allergic cross-reactivity to which of the following substances?
A. Latex
The client who has an allergy to bananas may also have an allergy to latex, as they share some common proteins that can trigger an immune response. The nurse should avoid using latex gloves, catheters, syringes, or other products that may contain latex when caring for this client. The other options are not related to banana allergy.
B. Anesthetics
C. Adhesive tape
D. Povidone-iodine
Full Explanation
The client who has an allergy to bananas may also have an allergy to latex, as they share some common proteins that can trigger an immune response. The nurse should avoid using latex gloves, catheters, syringes, or other products that may contain latex when caring for this client. The other options are not related to banana allergy.
A nurse is completing discharge teaching with a client who has a peripherally inserted central catheter (PICC) line in the left arm. Which of the following instructions should the nurse include in the teaching?
A. Use a 10-mL syringe to flush the line.
The nurse should instruct the client to use a 10-mL syringe or larger to flush the PICC line with normal saline or heparin solution, as prescribed, to prevent occlusion and thrombosis. The other options are incorrect because they may cause complications such as infection, phlebitis, or bleeding.
B. Do not elevate the arm above the level of the heart.
C. Change the catheter dressing daily.
D. Clean the insertion site using 20 mL of hydrogen peroxide.
Full Explanation
The nurse should instruct the client to use a 10-mL syringe or larger to flush the PICC line with normal saline or heparin solution, as prescribed, to prevent occlusion and thrombosis. The other options are incorrect because they may cause complications such as infection, phlebitis, or bleeding.
A nurse is preparing to administer peritoneal dialysis to a client. Which of the following actions should the nurse take?
A. Hang the drainage bag below the client's abdomen.
The nurse should hang the drainage bag below the level of the client's abdomen to facilitate gravity drainage of fluid and waste products from the peritoneal cavity. The other options are incorrect because they may cause discomfort, infection, or inadequate dialysis.
B. Use clean technique to access the catheter.
None
C. Place the client in high-Fowler's position.
None
D. Chill the dialysate before administration.
None
Full Explanation
The nurse should hang the drainage bag below the level of the client's abdomen to facilitate gravity drainage of fluid and waste products from the peritoneal cavity. The other options are incorrect because they may cause discomfort, infection, or inadequate dialysis.