A nurse is obtaining informed consent for an adolescent who is scheduled for a cardiac catheterization. The adolescent’s guardian states, “I don’t understand why they need to do this procedure.”. Which of the following actions should the nurse take?
Explain the procedure to the adolescent and their guardian.
Witness the adolescent’s signature on the informed consent form.
Request assistance from the anesthesiologist to clarify the misunderstanding.
Notify the provider who is scheduled to perform the procedure.
The Correct Answer is D
Choice A rationale
While explaining the procedure to the adolescent and their guardian is important, it is not the nurse’s primary responsibility to provide detailed explanations of the procedure. This should be done by the provider performing the procedure.
Choice B rationale
Witnessing the adolescent’s signature on the informed consent form is part of the nurse’s role, but it does not address the guardian’s lack of understanding about the procedure.
Choice C rationale
Requesting assistance from the anesthesiologist to clarify the misunderstanding is not appropriate, as the anesthesiologist may not be the best person to explain the procedure. The provider performing the procedure should be the one to provide clarification.
Choice D rationale
Notifying the provider who is scheduled to perform the procedure is the correct action. The provider is responsible for ensuring that the patient and their guardian fully understand the procedure and its risks and benefits before obtaining informed consent.
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Correct Answer is A
Explanation
Choice A rationale
Providing a doll for the 3-year-old child to imitate parental behaviors helps the child understand and adjust to the new role of being an older sibling. It allows the child to practice nurturing behaviors and can reduce feelings of jealousy or displacement by involving them in the care of the newborn.
Choice B rationale
Preparing the child for a change in all of their routines can be overwhelming and may cause unnecessary stress. It is more effective to maintain as much consistency as possible in the child’s routine while gradually introducing changes related to the new sibling.
Choice C rationale
Telling the child that they will now have a new playmate may create unrealistic expectations. A newborn is not immediately capable of playing, and this statement may lead to disappointment and frustration for the 3-year-old.
Choice D rationale
Waiting for the newborn to come home before moving the 3-year-old from the crib to a bed can create a sense of displacement and jealousy. It is better to make this transition well before the newborn’s arrival to allow the older child to adjust to the change independently of the new sibling.
Correct Answer is A
Explanation
Choice A rationale
The FLACC scale (Face, Legs, Activity, Cry, Consolability) is designed to assess pain in children who are unable to communicate their pain verbally, including those who are cognitively impaired. It evaluates five categories: facial expression, leg movement, activity, cry, and consolability, each scored from 0 to 2, with a total score ranging from 0 to 1012.
Choice B rationale
The FACES pain scale is a self-report tool that uses facial expressions to help children aged 3 and older communicate their pain level. It is not suitable for toddlers who are cognitively impaired and unable to self-report.
Choice C rationale
The Visual Analog Scale (VAS) is a unidimensional measure of pain intensity, typically used in older children and adults who can understand and mark their pain level on a continuum. It is not appropriate for toddlers who are cognitively impaired.
Choice D rationale
The CRIES scale is used to assess pain in neonates and infants, particularly postoperatively. It evaluates crying, oxygen requirement, increased vital signs, facial expression, and sleeplessness. It is not designed for toddlers.