The nurse is asked to witness surgical consent forms were obtained for clients, in the preoperative holding area. What client would not be able to consent legally to surgery?

The 22-year-old client who does not understand English

The 17-year-old client who has two fractured wrists

The 65-year-old client who cannot read or write

The 80-year-old client who is not oriented to the day

Answer and Explanation

The Correct Answer is D

A. The 22-year-old client who does not understand English: This client can still consent legally if provided with a translator or interpreter to ensure understanding.
B. The 17-year-old client who has two fractured wrists: This client is a minor and would typically need a legal guardian to consent, but their ability to consent is not the primary issue here.
C. The 65-year-old client who cannot read or write: Literacy issues do not necessarily preclude the ability to understand and consent, especially if the consent process is explained to them.
D. The 80-year-old client who is not oriented to the day: This client lacks orientation and thus may not be able to fully understand or make an informed decision about the surgery, affecting their ability to consent legally.

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Correct Answer is D

Explanation

A. Blood in the tubing close to the insertion site: This indicates a possible issue with the IV but not fluid overload specifically.
B. Chills, fever, and generalized discomfort: These symptoms may suggest an infection or reaction but are not specific to fluid overload.
C. Pallor, sweating, and discomfort at the insertion site: These could indicate a local reaction or issue with the IV site but not fluid overload.
D. Dyspnea, headache, and increased blood pressure: These symptoms are indicative of fluid overload, as the body reacts to excessive fluid with symptoms such as difficulty breathing (dyspnea), increased blood pressure, and headaches.

A. Assessing the surgical site before surgery B. Providing comfort for the client C. Reducing the risk of post-operative wound infection D. Sterilizing the skin for easier scalpel cutting

Correct Answer is C

Explanation

A. Assessing the surgical site before surgery: While assessing the surgical site is important, it is not the primary purpose of skin cleaning preparation. The focus is on reducing infection risk.
B. Providing comfort for the client: Comfort may be a secondary benefit, but it is not the main goal of surgical skin cleaning. The primary purpose is to reduce infection risk.
C. Reducing the risk of post-operative wound infection: Surgical skin cleaning preparation is aimed at minimizing the number of microorganisms on the skin to reduce the risk of postoperative wound infections. This is the key reason for preoperative skin preparation.
D. Sterilizing the skin for easier scalpel cutting: Skin cannot be completely sterilized, and the ease of scalpel cutting is not related to the cleanliness of the skin. The goal is infection control, not making the skin easier to cut.

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The nurse is asked to witness surgical consent forms were obtained for clients, in the preoperative holding area. What client would not be able to consent legally to surgery?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is monitoring a client who is receiving IV fluid. Which clinical findings indicate that the client has fluid overload?

Correct Answer is D

Explanation

A nurse is preparing the skin of a client scheduled for cardiac surgery. What is the purpose of surgical skin cleaning preparation?

Correct Answer is C

Explanation

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