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Who among the following is the BEST to sign an informed consent during a surgical procedure of a child at the health center?
- A. A 26 year old brother who is a drug addict
- B. A father who is 40 years old and illiterate
- C. A sister, 21 years old but undergoing dialysis
- D. A mother, 35 years old with on and off seizure illiterate person can sign the surgical consent form with an "X."
Correct Answer: D
Rationale: In this scenario, the mother, who is 35 years old and illiterate but with on and off seizure, is the best candidate to sign the informed consent for a surgical procedure for the child. The mother is the primary caregiver and decision-maker for the child in most cases, and her relationship to the child is most crucial in this situation. Despite her illiteracy, she can still comprehend the importance of the procedure for her child's well-being. Additionally, accommodations can be made for an illiterate person to sign the consent form by using an "X" as a signature. It is important that the person signing the consent form has a clear understanding of the risks and benefits involved, as well as the ability to make decisions in the best interest of the child.
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The nursing team plans to do chart audit project on post-op patients who and developed pressure sores at the Orthopedic unit over the past year to present. What type of audit is?
- A. Retrospective
- B. Concurrent
- C. Process
- D. Outcome
Correct Answer: A
Rationale: A retrospective audit involves reviewing past cases or data to evaluate processes, outcomes, or compliance with standards. In this scenario, the nursing team plans to audit post-op patients who developed pressure sores over the past year at the Orthopedic unit. By looking at historical data from the past year, the audit is considered retrospective as it assesses what has occurred over a specified period. This type of audit helps identify trends, patterns, and areas for improvement based on past events.
A patient is prescribed a nonsteroidal anti-inflammatory drug (NSAID) for the management of pain. Which adverse effect should the nurse monitor closely in the patient?
- A. Hypotension
- B. Hyperkalemia
- C. Gastrointestinal bleeding
- D. Hyperglycemia
Correct Answer: C
Rationale: NSAIDs are commonly known to increase the risk of gastrointestinal adverse effects, including gastritis, ulcers, and gastrointestinal bleeding. This risk is due to the inhibition of prostaglandin synthesis, which plays a protective role in the gastrointestinal mucosa. Gastrointestinal bleeding can manifest as symptoms such as black, tarry stools, vomiting blood, or abdominal pain. Therefore, it is crucial for the nurse to closely monitor the patient for signs and symptoms of gastrointestinal bleeding while taking NSAIDs to prevent potentially serious complications. Hypotension, hyperkalemia, and hyperglycemia are not commonly associated with NSAIDs use, making them less likely adverse effects to monitor for in this scenario.
A postpartum client expresses concern about feeling lightheaded when standing up. What should the nurse prioritize in the assessment to address this issue?
- A. Checking blood pressure
- B. Assessing for postural hypotension
- C. Evaluating hemoglobin levels
- D. Monitoring for signs of hemorrhage
Correct Answer: B
Rationale: Postural hypotension, also known as orthostatic hypotension, is a common issue postpartum and can cause lightheadedness when standing up. When a postpartum client expresses concern about feeling lightheaded, assessing for postural hypotension should be a priority. This assessment involves measuring the client's blood pressure while lying down, sitting, and standing to identify any significant drops in blood pressure upon changing positions. Identifying postural hypotension early allows for appropriate interventions to prevent potential falls and address the client's symptoms. Checking blood pressure, evaluating hemoglobin levels, and monitoring for signs of hemorrhage are also important assessments but may not directly address the specific issue of feeling lightheaded when standing up in this scenario.
A nurse is preparing to perform a wound irrigation procedure for a patient with a contaminated wound. What solution should the nurse use for wound irrigation?
- A. Sterile water
- B. Normal saline
- C. Hydrogen peroxide
- D. Betadine solution
Correct Answer: B
Rationale: Normal saline is the preferred solution for wound irrigation because it is isotonic and will not damage healthy tissue or delay wound healing. It helps to remove debris and pathogens from the wound, promoting a clean environment for healing. Sterile water can be used if normal saline is not available, but it may cause cellular damage if used in large volumes. Hydrogen peroxide and Betadine solution are not recommended for wound irrigation as they can be cytotoxic to the tissues and interfere with the wound healing process. It's important for the nurse to use evidence-based practice and follow recommended guidelines to promote optimal wound healing outcomes.
Nurse Emma advised the patient to quit smoking because nicotine wil1 contribute to _______.
- A. low birth weight infant
- B. ectopic tubal, pregnancy
- C. congenital anomalies
- D. large for gestation age infants
Correct Answer: A
Rationale: Nicotine, a substance found in cigarettes, is known to have harmful effects on pregnancy. Smoking during pregnancy can lead to numerous complications, one of which is the increased risk of delivering a low birth weight infant. Low birth weight infants are born weighing less than 5.5 pounds (2.5 kilograms) and are at a higher risk of various health issues, developmental delays, and even mortality. Therefore, Nurse Emma advised the patient to quit smoking to reduce the risk of having a low birth weight infant.