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A nurse reviewing prescriptions for a client who has a gastrointestinal bleed is determining the need for special informed consent. Which of the following prescriptions should the nurse identify as covered under the client's general consent for treatment?

A.

Abdominal CT scan with contrast.

B.

Esophagogastroduodenoscopy.

C.

Insertion of an NG tube to low intermittent suction.

D.

Administration of 1 unit of fresh frozen plasma.

Answer and Explanation

The Correct Answer is C

A. An abdominal CT scan with contrast typically requires specific informed consent due to the use of contrast material and potential risks associated with it.  

 

B. An esophagogastroduodenoscopy is an invasive procedure that necessitates special informed consent due to its risks and potential complications.  

 

C. The insertion of an NG tube to low intermittent suction is considered a routine procedure that is generally included under the client's general consent for treatment.  

 

D. The administration of fresh frozen plasma involves specific risks and usually requires informed consent because of the implications of blood product administration.


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Correct Answer is B

Explanation

A. Seclusion is a highly restrictive intervention and is not the first action for managing agitation in dementia clients.

B. Engaging the client in a repetitive activity as a distraction is the least restrictive intervention and can help calm the client by redirecting their attention. Non-pharmacological and less restrictive approaches are preferred as initial responses to manage agitation in dementia clients.

C. Administering PRN haloperidol IM is a pharmacological intervention and should be reserved for situations where less restrictive measures have failed.

D. Applying wrist restraints is a restrictive intervention that can increase agitation and is not appropriate as a first-line approach.

Correct Answer is A

Explanation

A. Ecchymoses (bruising) over the buttocks and lower back in an older adult could be a sign of physical abuse or an underlying bleeding disorder, and it should be reported immediately.

B. Hirsutism, or increased facial and chest hair, is a common age-related change and does not usually require reporting unless it indicates an endocrine disorder.

C. Reduced skin elasticity is a normal age-related finding due to decreased collagen and elastin in aging skin.

D. Increased macules, or age spots, are benign and typical with aging, especially with prolonged sun exposure, and do not require reporting.

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