The nurse is caring for a client on the medical-surgical unit who is scheduled for a right hip replacement surgery today. While completing the client assessment, the nurse notes the client has periods of intermittent confusion, sometimes forgetting where she is or why she is in the hospital. Consent for surgery has not yet been obtained. What is the priority action?
Reassess the client when the provider arrives to obtain the informed consent.
Notify the provider of the client's orientation.
Call the nursing supervisor to give consent for the surgery.
Ask another nurse to witness the informed consent.
The Correct Answer is B
Choice A reason: Reassessing the client when the provider arrives to obtain the informed consent may be necessary, but it is not the priority action. The nurse needs to ensure that the provider is aware of the client's current mental status before any attempt to obtain informed consent is made.
Choice B reason: Notifying the provider of the client's orientation is the priority action. The client's intermittent confusion indicates that she may not have the capacity to provide informed consent. The provider needs to be aware of this to take appropriate steps, such as involving a legal representative or family member, to obtain consent.
Choice C reason: Calling the nursing supervisor to give consent for the surgery is not appropriate. The nursing supervisor does not have the legal authority to provide consent on behalf of the client.
Choice D reason: Asking another nurse to witness the informed consent does not address the issue of the client's mental status and ability to provide informed consent. This action is not appropriate given the client's intermittent confusion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
Choice A reason: Confirming that the rehabilitation center has a room available at the time of transfer is essential to ensure the client has a designated space upon arrival. This helps prevent any delays or complications during the transfer process.
Choice B reason: Ensuring the client has possession of his valuables is important for safeguarding the client's personal belongings during the transfer. This task helps prevent any loss or misplacement of valuable items.
Choice C reason: Completing a transfer form for the receiving facility is a critical task that involves documenting the client's medical information, treatment plan, and other relevant details. This form ensures that the receiving facility has all the necessary information to continue the client's care seamlessly.
Choice D reason: While assessing how the client tolerates the transfer is important, it is typically done after the transfer has occurred, rather than being a responsibility of the nurse at the sending facility. This task is more relevant to the receiving facility's staff.
Choice E reason: Sending a copy of the client's chart with diagnostic and laboratory results ensures that the receiving facility has access to the client's medical history, test results, and other pertinent information. This facilitates continuity of care and informed decision-making.
Correct Answer is B
Explanation
Choice A reason: Reassessing the client when the provider arrives to obtain the informed consent may be necessary, but it is not the priority action. The nurse needs to ensure that the provider is aware of the client's current mental status before any attempt to obtain informed consent is made.
Choice B reason: Notifying the provider of the client's orientation is the priority action. The client's intermittent confusion indicates that she may not have the capacity to provide informed consent. The provider needs to be aware of this to take appropriate steps, such as involving a legal representative or family member, to obtain consent.
Choice C reason: Calling the nursing supervisor to give consent for the surgery is not appropriate. The nursing supervisor does not have the legal authority to provide consent on behalf of the client.
Choice D reason: Asking another nurse to witness the informed consent does not address the issue of the client's mental status and ability to provide informed consent. This action is not appropriate given the client's intermittent confusion.
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