A nurse is counseling a group of clients from a town that was affected by a hurricane 6 months ago. For which of the following clients should the nurse initiate a referral to assess for the presence of post-traumatic stress disorder? (Select all that apply)

Choice A reason: Asking for more information about the surgery indicates the client seeks clarification but does not confirm understanding of informed consent. Informed consent requires comprehension of the procedure, risks, benefits, and alternatives, with agreement to proceed. This statement reflects curiosity, not confirmation of understanding, making it insufficient to demonstrate informed consent.
Choice B reason: Planning to ask the doctor about the surgery in the operating room suggests the client has not yet received or understood the necessary information. Informed consent must be obtained before entering the operating room, with full comprehension of risks and benefits. This statement indicates a lack of prior understanding, making it incorrect.
Choice C reason: Stating understanding of the risks, benefits, and agreement to the procedure demonstrates informed consent. This reflects that the client has been educated about the knee arthroplasty, including potential complications like infection or blood clots, and alternatives, and voluntarily agrees to proceed. This meets legal and ethical standards, indicating full comprehension and consent.
Choice D reason: Having family sign the consent form is inappropriate unless the client lacks decision-making capacity, which is not indicated. Informed consent requires the competent client’s understanding and agreement. This statement suggests reliance on others, not personal comprehension of the procedure’s risks and benefits, making it an incorrect indicator of understanding.

Choice A reason: Performing postural drainage immediately after meals risks aspiration and discomfort due to gastric contents shifting during positioning. It should be done 1-2 hours after meals to ensure safety and efficacy in clearing mucus from the lungs, making this timing inappropriate for cystic fibrosis management.
Choice B reason: Performing postural drainage twice daily is recommended for cystic fibrosis to mobilize thick mucus from the lungs, improving airway clearance and reducing infection risk. This frequency balances effectiveness with patient tolerance, aligning with evidence-based guidelines for managing chronic respiratory conditions, making it the correct action.
Choice C reason: Using a percussion vest is an alternative to manual postural drainage but is not specified as the only method. Manual techniques are effective and standard unless a vest is prescribed. This choice assumes equipment availability, which may not apply, making it less universally appropriate than scheduled manual drainage.
Choice D reason: Positioning the child flat during postural drainage is incorrect, as specific angled positions (e.g., head-down) are needed to target lung segments and promote mucus drainage by gravity. Flat positioning reduces effectiveness and may not clear airways adequately, making this an inappropriate technique for cystic fibrosis.