A nurse is caring for a client who is recovering from a stroke. The provider recommends an extracranial-intracranial bypass, but the client tells the nurse that he will not have the surgery. Which of the following actions should the nurse take?

Inform the client of the consequences of decreased cerebral circulation.

Initiate a mental health consultation to determine why the client refuses the surgery.

Discuss the client's concerns about having the surgery.

Provide the client with information on additional treatment options.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Informing the client of the consequences of decreased cerebral circulation is premature without understanding the client's specific reasons for refusing the surgery. Jumping to consequences might not address the underlying fears or concerns the client has, potentially leading to increased resistance or anxiety.

Choice B rationale:

Initiating a mental health consultation is a valuable step if the client's refusal appears to be influenced by psychological or emotional factors. However, before involving mental health professionals, it's important for the nurse to engage in a direct conversation with the client to explore their thoughts, fears, and reservations.

Choice C rationale:

Discussing the client's concerns about having the surgery is the most appropriate action in this scenario. Engaging in an open and nonjudgmental conversation allows the nurse to understand the client's perspective, provide information, clarify misconceptions, and address any fears or uncertainties. This approach respects the client's autonomy and promotes shared decision-making.

Choice D rationale:

Providing the client with information on additional treatment options might be premature if the client's main concern is related to the current recommended surgery. It's crucial to first address the client's specific reservations before exploring other treatment possibilities.

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Correct Answer is B

Explanation

The correct answer is choice B: "Ask the client to explain the procedure that is being performed."

Choice A rationale:

While verifying that the client understands the risks of the surgery (Choice A) is important, the question specifically asks about verifying informed consent. Informed consent involves ensuring that the patient comprehends the procedure being performed, its benefits, risks, and alternatives. While understanding the risks is a part of this, it's not the complete picture.

Choice B rationale:

The correct response is "Ask the client to explain the procedure that is being performed." This approach ensures that the client truly comprehends the procedure and its implications. If the client can accurately explain the procedure, it indicates a better understanding of what they are consenting to, which aligns with the concept of informed consent.

Choice C rationale:

Answering the client's questions about the outcomes of the surgery (Choice C) is important for providing education and addressing concerns, but it doesn't directly verify informed consent. The focus of informed consent is on the procedure itself, including its nature, purpose, and potential risks.

Choice D rationale:

Determining if the client understands the benefits of the procedure (Choice D) is only part of the informed consent process. While understanding the benefits is essential, it's equally important to ensure the client comprehends the risks and alternatives, which is better assessed by having the client explain the procedure.

A. Notify the charge nurse of the client's request for transfer. B. Assure the client that their concern has been shared with the staff. Tell the client that future calls will be answered in a timely manner. C. Ask the client to verbalize their expectations.

Correct Answer is C

Explanation

Choice A rationale:

Notify the charge nurse of the client's request for transfer. This action might be taken eventually, but it is not the first step. The nurse should directly address the client's concerns before escalating the situation to the charge nurse.

Choice B rationale:

Assure the client that their concern has been shared with the staff. Tell the client that future calls will be answered in a timely manner. While it's important to reassure the client, promising timely responses to calls before understanding their expectations might not effectively address the underlying issue. It's better to communicate openly with the client first.

Choice C rationale:

Ask the client to verbalize their expectations. This is the correct choice. By asking the client to express their expectations, the nurse can gather crucial information about the client's concerns and needs. This allows the nurse to address the specific issues that led to the client's dissatisfaction and work toward a resolution that aligns with the client's preferences.

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A nurse is caring for a client who is recovering from a stroke. The provider recommends an extracranial-intracranial bypass, but the client tells the nurse that he will not have the surgery. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is scheduled for outpatient surgery. Which of the following actions should the nurse take to verify the client gave informed consent?

Correct Answer is B

Explanation

A client on a general surgical unit tells a nurse that staff members are not answering the call light promptly. The client requests to be transferred to another unit. Which of the following actions should the nurse take first?

Correct Answer is C

Explanation

A nurse is caring for a client who has osteoarthritis and reports difficulty buttoning their clothes. The nurse should recommend a referral for the client to which of the following members of the interprofessional team?

A nurse is caring for a client who is terminally ill and receiving nutritional support. The client's adult children disagree about continuing nutritional support. The dilemma is referred to the ethics committee. Which of the following actions should the nurse expect the committee to take?

A nurse is developing a plan of care for a school-age child whose family is homeless. Which of the following findings should the nurse identify as the priority?

A charge nurse is planning client care assignments for a unit. Which of the following tasks should the nurse assign to a licensed practical nurse (LPN)?

A nurse on a medical-surgical unit is caring for a client transferred from another department. The nurse should verify that the client has given informed consent prior to which of the following procedures?

A case manager is planning an interprofessional conference for a client who is 3 days postoperative following an open reduction and internal fixation of the right hip. Which of the following concerns is the priority for discussion at the conference?

A nurse is caring for four clients. Which of the following assessment findings is the priority?

A nurse manager is auditing client charts and identifies an increase in ventilator-associated pneumonia (VAP). Which of the following actions should the nurse manager take?