Question

183. The nurse is caring for assigned clients. The nurse should first evaluate the equipment of a client who has

1.a patient-controlled analgesia (PCA) device and reports that the medication is not received each time that the button on the pump is activated.

2.a pulse oximeter sensor attached to the finger and reports that the numbers on the pulse oximeter screen change every few seconds.

3.a nasogastric (NG) tube connected to low, intermittent suction and reports that bubbles appear in the NG tubing when the machine turns on.

4.sequential compression stockings and reports that the stockings have remained inflated for the past several minutes.

15. The nurse has reinforced teaching with a female client who sustained a spinal cord injury at T5 three weeks ago. Which of the following statements by the client would indicate a correct understanding of the teaching? Select all that apply.

1."I need to maintain a fluid intake of at least 2 L daily."

2."I will be able to ambulate with crutches once I have completed physical therapy."

3."I will need to perform range-of-motion (ROM) exercises several times each day."

4."I should see a fertility specialist if I want to conceive a child because I may be infertile."

5."I should notify my primary health care provider if I experience a pounding headache."

235. The nurse and unlicensed assistive personnel (UAP) are caring for assigned clients. Which of the following activities would be appropriate for the nurse to assign to a UAP? Select all that apply.

1.weighing the client with heart failure

2.providing oral hygiene for the client with severe Alzheimer's disease (AD)

3.palpating the pedal pulses of the client who had a cardiac catheterization 2 hours ago

4.obtaining and documenting vital signs from the client who had an appendectomy 24 hours ago

5.obtaining a pulse oximetry reading from the client with chronic obstructive pulmonary disease (COPD)

44. The nurse is planning a staff education conference about informed consent. Which of the following information should the nurse include? Select all that apply.

1. "The main value of informed consent is for protection against lawsuits."

2. "Clients may withdraw consent after signing the informed consent form."

3. "Clients must sign the informed consent form before receiving preprocedural medication."

4 "Nurses witness the signing of the informed consent form to confirm that consent is voluntary."

5 "The signed consent form serves as evidence that the informed consent process has taken place."

Answer 1

183. ANSWER IS 3 A nasogastric (NG) tube connected to low, intermittent suction and reports that bubbles appear in the NG tubing when the machine turns on.

Consider an NGT as a way of putting something in or a way of taking something out. Fine bore tubes are inserted as an alternative means of feeding sick or immature neonates with a poor suck/swallow reflex or those in whom oral feeding is contraindicated (e.g. certain neurological disorders). In older children, they may be used as an alternative means of hydration when you don’t want to use an IV.

They also allow the passage of insufflated air out of the stomach in intubated infants and children. Neonates on nCPAP or high-flow might be better served with an orogastric tube.

Finally, they can be used as a diagnostic aid in cases of suspected choanal atresia or tracheo-oesophageal fistula.

15.Only 1, 2 3 options are right

option 4 is not correct because women can become pregnant for the injury

option 5 is not correct because head ache will only cause for spine location L3,L4 and L5.

235. All options are right ,

The activities that are appropriate to delegate to UAP's are as follows:

1. clerical duties.

2. selected care tasks such as ambulation, feeding, mouth care, and bathing.

3. data gathering such as intake and output and vital signs.

44. 1,2,3,4,5 options are right:

1.The main value of informed consent is for protection against lawsuits."

2. "Clients may withdraw consent after signing the informed consent form."

3."Clients must sign the informed consent form before receiving preprocedural medication."

4 "Nurses witness the signing of the informed consent form to confirm that consent is voluntary."

5 "The signed consent form serves as evidence that the informed consent process has taken place."

Signing the consent form is NOT the final step in the informed consent process. The participant may withdraw consent and decline to participate in the study at any time before or after signing the consent document until their participation in the study is completed.

The nurse is responsible and accountable for the verification of and witnessing that the patient or the legal representative has signed the consent document in their presence and that the patient, or the legal representative, is of legal age and competent to provide consent.

The main purpose of the informed consent process is to protect the patient. A consent form is a legal document that ensures an ongoing communication process between you and your health care provider.

Explanation for option 3:

The patient must sign the consent form before psychoactive premedication is administered because consent may not be valid if it's obtained while the patient is under the influence of medications that can affect judgment and decision-making capacity.