Nursing Elites

1. The nurse in the emergency room is admitting a client who has sustained a gunshot wound and will require immediate surgery. The client is unconscious and by themselves. Which of the following actions is most appropriate?

• A. Call the charge nurse and request that the facility's legal counsel provide a waiver for informed consent.
• B. Attempt to stabilize the client in the emergency room until they are conscious enough to provide informed consent.
• C. Try to locate the client's family to obtain informed consent before transporting the client to the operating room.
• D. Proceed with transporting the client to the operating room without obtaining informed consent.

Correct answer: D

Rationale: In emergency situations where a client is unconscious and requires immediate surgery to save their life, the priority is to proceed with necessary interventions without delay to ensure the best possible outcome. Obtaining informed consent is essential in healthcare, but in situations where a delay in treatment can be life-threatening, healthcare providers are ethically and legally permitted to proceed with treatment without consent. Attempting to stabilize the client until conscious enough to provide consent or trying to locate family members for consent would cause a dangerous delay in critical care. Therefore, the most appropriate action in this scenario is to transport the unconscious client to the operating room for immediate surgery.

2. When a 17-year-old client arrives at the clinic suspecting a sexually transmitted infection, what information does the nurse provide concerning informed consent?

• A. She will need to sign an informed consent form.
• B. Her mother or father will need to be contacted for permission to treat her.
• C. A consent form is not needed if the problem is a sexually transmitted infection.
• D. Anyone over the age of 18 years may sign a consent form for her treatment.

Correct answer: A

Rationale: Informed consent is a person's agreement to allow something, such as a treatment, to be performed. A consent form is required even if the problem is a sexually transmitted infection. If the client is a minor, the minor may sign the informed consent form in specific situations, including seeking treatment for a sexually transmitted infection. In this case, the 17-year-old client is seeking examination and treatment for a sexually transmitted infection, so she will need to sign the informed consent form. Contacting her parents for permission is not required in this situation. Choice C is incorrect because a consent form is necessary regardless of the medical issue. Choice D is incorrect because the individual's age is not the determining factor; rather, it is the nature of the medical service being sought that dictates the need for informed consent.

3. The LPN is preparing to clean a client's PEG tube.The following tasks should the nurse perform EXCEPT?

• A. Gently remove crusty drainage from the site.
• B. Pull the tube in multiple directions to ensure it is secure.
• C. Thoroughly dry the skin around the tube site with a clean towel.
• D. Use mild soap to clean around the tube site.

Correct answer: B

Rationale: When cleaning a client's PEG tube, the nurse should perform tasks that focus on gentle cleaning and avoiding potential irritants. Choice A is correct as gently removing crusty drainage helps maintain hygiene. Choice C is important to prevent skin irritation and infection. Choice D is appropriate for cleaning the area. Choices B and D are incorrect. Choice B is incorrect because pulling the tube in multiple directions can lead to dislodgement or injury. Choice B is incorrect as talcum powder may irritate the stoma, and it is generally not recommended near PEG tubes.

4. The LPN has been given assignments by the RN. Which assignment should the LPN question as being beyond the scope of the LPN?

• A. The LPN is assigned to care for a client with diabetes mellitus who needs instructions reinforced on how to self-administer insulin.
• B. The LPN is assigned to reinforce discharge teaching about dressing changes and medications to a 35-year-old man.
• C. The LPN is assigned to care for a 75-year-old woman, hospitalized for dehydration, who is being discharged home today with no medications.
• D. The LPN is assigned to care for a woman with newly diagnosed leukemia who will be receiving her initial dose of chemotherapy.

Correct answer: D

Rationale: The LPN should be able to recognize when an assignment is beyond their scope of practice. Administering chemotherapy for leukemia is not within the scope of practice for the LPN, and this assignment should be questioned. Choices A, B, and C are within the scope of practice for an LPN. Reinforcing teaching on self-administration of insulin, assisting with discharge instructions on dressing changes, and caring for a client being discharged with no medications are all appropriate tasks for an LPN.

5. Ethical and moral issues concerning restraints include all of the following except:

• A. emotional impact on the client and family
• B. dignity of the client
• C. client's quality of life
• D. policies and procedures

Correct answer: D

Rationale: The correct answer is 'policies and procedures.' While policies and procedures are important for guidance and structure, they do not inherently involve ethical or moral considerations. The emotional impact on the client and family, the dignity of the client, and the client's quality of life are all directly related to ethical and moral concerns when it comes to the use of restraints. These factors are crucial in ensuring that the use of restraints is not only physically necessary but also ethically justifiable and respects the individual's rights and well-being. Therefore, options A, B, and C are all aspects that touch upon ethical and moral dimensions in the context of restraints.

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