The nurse at an outpatient surgical clinic witnesses clients' signatures. When obtaining signatures, which clients can sign their own consent for a procedure/surgery? Select All That Apply.
A 72-year-old widow with dementia who needs a mastectomy for cancer removal
A 62-year-old with macular degeneration who is ordered a routine colonoscopy
A 7-year-old who needs an open reduction internal fixation (ORIF) of the right arm
A married 17-year-old who requires a cholecystectomy for relief of nausea and pain
A 16-year-old who is obtaining an elective breast reduction for back pain relief
Correct Answer : B,D
Informed consent requires cognitive competence and legal capacity to authorize medical interventions. This ethical-legal framework ensures autonomy, requiring the disclosure of procedural risks, benefits, and alternatives to a patient who is not incapacitated.
Rationale:
A. Clients with progressive dementia lack the cognitive capacity to understand complex surgical risks. In such cases, a legal guardian or a designated power of attorney must provide consent to ensure the patient's best interests are protected.
B. Visual impairments like macular degeneration do not affect a client's legal or mental competence. As long as the procedural details are explained verbally, the client retains the autonomy to sign their own surgical consent forms.
C. Minors generally lack the legal standing to provide informed consent for invasive surgeries. For a 7-year-old, a parental guardian must sign the authorization after the surgeon explains the surgical plan and potential complications.
D. Marriage typically grants a minor emancipated status, allowing them to make independent healthcare decisions. This legal emancipation permits the 17-year-old to sign the surgical consent for their own cholecystectomy without requiring parental involvement.
E. A 16-year-old is legally a minor and cannot provide independent consent for elective procedures. Unless they are an emancipated minor, the signature of a legal guardian is mandatory before the medical team can proceed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Dementia-related agitation often stems from unmet needs or environmental overstimulation, necessitating a focus on safety and physical integrity. Before implementing mechanical immobilization, a thorough physical assessment is mandatory to establish a baseline and prevent iatrogenic injury. The nurse must prioritize the protection of cutaneous tissues, as frail elderly patients are highly susceptible to pressure-related trauma and localized ischemia during restrictive interventions.
Rationale:
A. Securing the device to the bed frame with a quick-release knot is a vital safety step during the actual application process. However, the nurse must complete a thorough pre-application assessment of the patient's physical status before initiating the tethering process. Ensuring the knot is accessible allows for rapid removal during a clinical emergency or fire.
B. Verifying that the vest is oriented correctly with the opening at the posterior prevents the risk of accidental strangulation or restricted thoracic expansion. While correct orientation is essential for device efficacy, it follows the initial assessment of the patient's skin and underlying physical condition. Proper fit ensures the device functions as intended without causing secondary physical harm.
C. Inspecting the skin is the highest priority to ensure there are no existing lesions or areas of compromised circulation before restraint. Applying a vest over damaged tissue can lead to rapid necrosis or exacerbate underlying skin breakdown due to friction and pressure. Documentation of the skin’s integrity provides a critical baseline for ongoing monitoring and legal compliance.
D. Maintaining adequate space between the patient and the material ensures that respiratory excursion and peripheral circulation are not impeded. While the "two-finger" or "four-finger" rule is a standard evaluative measure after the vest is on, it is a component of fitting rather than the initial assessment. The nurse must first ensure the site is healthy enough to tolerate the device.
Correct Answer is ["200"]
Explanation
Step 1: Identify total volume and time
Total volume = 100 mL, Time = 30 minutes = 0.5 hours
Step 2: Use the formula
mL/hour = Total volume ÷ Time (in hours)
Step 3: Insert values
= 100 ÷ 0.5
Step 4: Calculate
= 200 mL/hour
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