Nokea
An adult client has been medicated for elective surgery. The operating room nurse discovers that the consent form for surgery has not been signed. What should the nurse do?
- A. Have the client sign the consent form
- B. Tell the physician that the consent form has not been signed
- C. Have the client's spouse sign the consent form
- D. Continue preparation for surgery because the client has given implied consent
Correct Answer: B
Rationale: Preoperative medications impair judgment, making consent invalid post-administration. Notifying the physician ensures legal and ethical consent is obtained, delaying surgery if needed.
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Following an arteriogram, the nurse should give priority to:
- A. Allowing the client to rest
- B. Administering O2 via nasal mask
- C. Checking the ECG monitor
- D. Checking the pulses distal to the catheterization site
Correct Answer: D
Rationale: Checking distal pulses ensures adequate circulation post-arteriogram, as the procedure involves arterial puncture, which can lead to complications like hematoma or thrombosis.
The nurse is beginning nutritional counseling/teaching with a pregnant woman. What is the initial step in this interaction?
- A. Teach her how to meet the needs of self and her family
- B. Explain the changes in diet necessary for pregnant women
- C. Question her understanding and use of the food pyramid
- D. Conduct a diet history to determine her normal eating routines
Correct Answer: D
Rationale: Assessment is always the first step in planning teaching for any client. A thorough and accurate history is essential for gathering the needed information.
The practical nurse is collaborating with the registered nurse to form a care plan for a client diagnosed with placenta previa at 33 weeks gestation. Which of the following does the nurse anticipate being included in the plan of care? Select all that apply.
- A. Activity as tolerated
- B. Nonstress test 1 or 2 times per week
- C. Prepare for cesarean birth at any time
- D. Type and screen blood
- E. Vaginal examinations twice weekly
Correct Answer: B, C, D
Rationale: Nonstress tests (B), cesarean preparation (C), and type and screen (D) monitor and prepare for bleeding risks in placenta previa. Activity as tolerated (A) and vaginal exams (E) increase bleeding risk.
Which of the following infractions can result in the revocation of the nurse's license?
- A. Failure to render care during a natural disaster
- B. Suspected negligence
- C. A felony conviction
- D. Failure to pay license renewal fees
Correct Answer: C
Rationale: A felony conviction can lead to license revocation due to its impact on professional integrity. Natural disaster response, negligence, or unpaid fees may have other consequences but are less likely to cause revocation.
A postoperative client with obesity and diabetes mellitus has an abdominal wound and is at risk for poor wound healing. Which of the following interventions does the nurse anticipate to prevent wound dehiscence? Select all that apply.
- A. Administer docusate sodium orally every day
- B. Assist in applying an abdominal binder
- C. Implement caloric restriction to promote weight loss
- D. Monitor blood glucose to maintain tight control
- E. Reinforce teaching to hug a pillow while coughing
Correct Answer: B, D, E
Rationale: Abdominal binder (B), glucose control (D), and pillow hugging (E) reduce wound stress and promote healing. Docusate (A) prevents constipation but not dehiscence, and caloric restriction (C) is inappropriate post-surgery.