A staff nurse is teaching a newly hired nurse how to complete an informed consent document for a client. The staff nurse should include that the nurse's signature on the form confirms which of the following requirements? (Select all that apply.)

The client has legal authority to do so.

The client does not have a mental health condition.

The client was not coerced.

The client signed in the nurse's presence.

The client speaks the same language as the nurse.

Answer and Explanation

Correct Answer : A,C,D

A. The client has legal authority to do so: The nurse’s signature confirms that the client appears to have the legal capacity to consent.

B. The client does not have a mental health condition: This is not within the nurse’s purview to assess unless explicitly stated; mental capacity, not condition, is key.

C. The client was not coerced: The nurse’s signature also indicates the consent was given voluntarily, without coercion.

D. The client signed in the nurse's presence: The nurse’s signature confirms that the nurse witnessed the client’s signature.

E. The client speaks the same language as the nurse: Consent requires understanding, which can be provided through an interpreter, so this is not necessary.

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Correct Answer is A

Explanation

A. Postural hypotension: Postural hypotension (a drop-in blood pressure when moving to a standing position) is a common sign of extracellular fluid volume deficit due to decreased circulating blood volume.

B. Dependent edema: This occurs with fluid volume excess, not deficit, due to fluid accumulation in tissues.

C. Bradycardia: Fluid volume deficit often leads to tachycardia as the body compensates for low blood volume, rather than a slow heart rate.

D. Distended neck veins: Distended neck veins suggest fluid overload, not a fluid deficit.

A. "Most people in your situation are able to get through this." B. "Why do you think you're feeling so alone?" C. "Do you have anyone you can talk to about your diagnosis?" D. "I am so sorry about your diagnosis. You must be devastated."

Correct Answer is C

Explanation

A. "Most people in your situation are able to get through this.": This statement is dismissive and may minimize the client’s feelings, as it generalizes the experience.

B. "Why do you think you're feeling so alone?": Asking "why" may make the client feel defensive and pressured to justify their feelings, which is not therapeutic.

C. "Do you have anyone you can talk to about your diagnosis?" This response encourages the client to reflect on their support system, which may help reduce feelings of isolation. It also shows empathy and invites further conversation without making assumptions.

D. "I am so sorry about your diagnosis. You must be devastated.": While it shows sympathy, it assumes the client’s feelings and may inadvertently heighten the client’s sense of distress without providing support.

View Question and Answer

What subjective assessment information in this client situation is the most important and immediate concern for the nurse?

View Question and Answer

A staff nurse is teaching a newly hired nurse how to complete an informed consent document for a client. The staff nurse should include that the nurse's signature on the form confirms which of the following requirements? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has an extracellular fluid volume deficit. Which of the following findings should the nurse expect?

Correct Answer is A

Explanation

A nurse is caring for a client who was recently diagnosed with breast cancer. The client states, "I feel so alone. I don't know how I will be able to deal with this." Which of the following responses should the nurse make?

Correct Answer is C

Explanation

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