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27 Cards in this Set

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  • Back
A nurse is aware that compulsive behavior usually incorporates the defense mechanism of?
Displacement- redirection of an emotion from a threatening source to a non-threatening source
When obtaining informed consent from a developmentally challanged adult the nurse must be sure that?
she must be sure that the client comprehends the outcome of the procedure to give informed consent - if not then the legal guardians must perform this function
A female client is scheduled for a hysterectomy. When discussing the preoperative prep. the nurse identifies that the client has no understanding of the surgery. The nurse should?
Notify the surgeon that the pt needs information. by law the surgeon must make sure the pt understands. the nurse may clarify info, witness the pts signiture and cosign the consent form
A client in labor is being prepared for a cesarean birth. The most important nursing intervention before the anesthesia is administered would be to?
Obtain an informed consent
New parents question a nurse about circumcision. Can the nurse help them with this decision?
yes, she can talk to them about the advantages and disadvantages-this will help them make the decision (of which the nurse cannot involve herself)
Parent's do not want their newborn's eyes treated with a prophylactic agent. The nurse's best response to this would be?
You will have to sign an informed consent to refuse the treatment
A 16 yr old, her 1 mth old baby and the baby"s grandmother come to the ER for trmt of an accident with the baby. Legal consent for the baby's medical care should come from?
The mother of the baby. Minor mothers (in most states) are considered emancipated minors and can sign consents for themselves and their children
An 8 yr old reports to the school nurse that she does not want to go to her grandfather's this weekend because he touches her down there. What legally should the nurse do?
By law suspected abuse must be reported to the proper state agency for further investigation. The nurse is never to speak to family members about this.
There is a 13 yr old mother and 16 yr old father at the bedside of an infant, along with the grandmother who takes care of the infant. Who should the nurse ask to give informed consent?
regardless of age, the parents will sign the consent
When a nurse suspects that a child has been abused, the nurse's primary responsibility must be to?
Protect the child from further abuse by reporting to the correct agency. Treatment, if not life threatening takes 2nd place.
a male lawyer has been commited to a psychiatric facility for schizophrenia. He runs away. the immediate responsibility of the nurse would be to notify the?
Law enforcement officers
When planning nursing care for the pt with severe agoraphobia, the nurse should first?
determine the client's degree of impairment. Assessment first
After speaking with the parents of a child dying from leukemia, the physician gives a verbal DNR order but refuses to put it in writing. The nurse should?
Determine whether the family is in accord with the doctor and follow hospital policy
At times a pt's anxiety level is so high it blocks attempts at communication and the nurse is unsure of what is being said. To clarify understanding, the nurse states, "let's see whether we both mean the same thing" This is an ex. of the technique of?
Seeking consensual validation-this prevents misunderstanding
3 days after a stressful incident a pt can no longer remember what there was to worry about. The nurse, in relating to this pt, can be most therapeutic by recognizing that the inability to recall the situation is an ex of the defense mechanism of?
Repression
A goal for a pt with the nursing diagnosis of impaired verbal communication related to psychologic barriers would be that the pt will?
Interact with others in the external environment:
this is appropriate and measurable
The nurse is aware that value clarification is a technique useful in therapeutic communication in that it helps?
makes pts aware of their personal values-a technique that uncovers a pts values and allows others to be aware of them
The nurse must recognize that when a pt is a member of a different ethnic community it is important to?
offer a therapeutic regimen compatible to the lifestyle of the family
A 22 yr old AIDs pt signs a DNR order when he is admitted to the hospital. When respiratory arrest occurs 3 wks later, the pt is not resuscitated. A true statement about the legal aspects of a DNR order would be
The status of the DNR order is contingent on the policies of the institution
A client is scheduled for surgery. legally, the client may not sign the operative consent if?
Any sedative type of meds has recently been given
A pt with ascites is to have a paracentesis and has signed the consent. While the nurse is caring for him, he says that he has changed his mind and no longer wants the procedure. The best initial response by the nurse would be?
" Can you tell me why you decided to refuse the procedure?" this promotes communication
A nurse stops at the scene of an accident and finds a man with a deep laceration on his hand, a fractured arm and leg, and abdominal pain. The nurse wraps the man's hand in a soiled cloth and drives him to the nearest hospital. The nurse is?
Negligent and can be sued for malpractice - the nurse needs to function in a responsible and prudent manner, the use of a soiled cloth on an open wound is not prudent, nor is the transfer of an accident victim from the scene
A visitor ask a nurse what the pt in the next room is in for. The nurse responds" I will not discuss any client's illness with you. Are you concerned about it?" This response is based on the nurse's knowledge that to discuss a pt's condition with someone not directly involved with that pt is an ex. of?
Breach of confidentiality and invasion of privacy
When approaching homosexual clients with AIDS, it is most important for nurses to?
Become aware of their own attitudes regarding homosexuality
A female client with a terminal illness decides to donate her eyes for organ transplantation after she dies. Statutes that address organ transplantation attempt to prevent abuse by?
requiring participating institutions to have review boards
A client is transferred from the coronary care unit to a progressive care unit. The cliens asks the nurse, "Are you sure I'm ready for this move?" From this statement the nurse ascertains that the client is most likely experiencing
Fear
The nurse should be aware that the defense mechanism a client with the diagnosis of schizophrenia, undifferentiated type, would most probably exhibit is?
Regression-they reduce anxiety by returning to an earlier behavior