A nurse is caring for a client in a geriatric unit.

Exhibits

For each client finding below, indicate if the finding is a best practice for managing enteral feeding tube safety or potential risk. Each finding may be associated with more than one category.

Ignoring cuff pressure during feeding

Checking tube placement before each feeding

Head of bed elevation at 30 degrees

Monitoring for signs of aspiration

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A"}}

Rationale:

Ignoring cuff pressure during feeding: Failure to monitor cuff pressure can increase the risk of aspiration or injury to the trachea if the cuff is underinflated or overinflated. Maintaining appropriate cuff pressure is critical for airway protection in clients with feeding tubes.
Checking tube placement before each feeding: Verifying placement reduces the risk of feeding into the lungs, preventing aspiration and ensuring proper nutrition delivery.
Head of bed elevation at 30 degrees: Maintaining the head of the bed elevated decreases the likelihood of reflux and aspiration, which is essential for enteral feeding safety.
Monitoring for signs of aspiration: Observing for coughing, choking, or changes in respiratory status allows early intervention to prevent respiratory complications during tube feeding.

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Correct Answer is B

Explanation

A. Medical malpractice prevention: Malpractice prevention relates to protecting healthcare providers from negligence claims but does not establish a patient’s right to refuse care. It is focused on provider accountability, not patient autonomy.

B. Informed consent: Informed consent ensures that patients receive adequate information about the benefits, risks, and alternatives of treatment before agreeing or refusing to proceed. This legal and ethical principle upholds the patient’s right to autonomy and self-determination.

C. Patient confidentiality: Confidentiality protects private health information but does not give the patient the legal right to refuse treatment. It governs how information is shared, not decision-making authority about care.

D. Advance directives: Advance directives are used to communicate treatment preferences when a patient is unable to speak for themselves. While important, they do not serve as the primary legal foundation for a competent patient’s immediate right to refuse treatment.

A. Obtain consent from the client without confirming understanding B. Provide education to decrease the client's anxiety C. Coerce the client into giving consent quickly. D. Verify the client understands the information provided E. Ignore the client's questions about the procedure. F. Ensure the client is legally capable of consenting

Correct Answer is ["B","D","F"]

Explanation

A. Obtain consent from the client without confirming understanding: Consent is not valid unless the client fully understands the procedure, risks, and benefits; skipping this step is unsafe and legally problematic.
B. Provide education to decrease the client's anxiety: Explaining the procedure, risks, and benefits helps the client make an informed decision and reduces fear, which is essential for valid verbal consent.
C. Coerce the client into giving consent quickly: Coercion invalidates informed consent and violates ethical and legal standards of care.
D. Verify the client understands the information provided: Ensuring comprehension confirms that the client can make an informed choice, which is a key element of informed consent.
E. Ensure the client is legally capable of consenting: The client must have the legal capacity to consent, including age and mental competency, to validate the agreement for the procedure.
F. Ignore the client's questions about the procedure: Failing to answer questions prevents the client from making an informed decision, which is a violation of patient rights and informed consent principles.

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A nurse is caring for a client in a geriatric unit. Exhibits For each client finding below, indicate if the finding is a best practice for managing enteral feeding tube safety or potential risk. Each finding may be associated with more than one category.

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Naxlex Comprehensive Predictor Exams

What is the primary legal basis that supports a patient's right to refuse medical advice?

Correct Answer is B

Explanation

A nurse is caring for a client in the emergency department. Exhibits Which 3 actions should the nurse take to ensure the client gives informed verbal consent?

Correct Answer is ["B","D","F"]

Explanation

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A nurse is caring for a client in a geriatric unit.

Exhibits

For each client finding below, indicate if the finding is a best practice for managing enteral feeding tube safety or potential risk. Each finding may be associated with more than one category.