Correct Answer: C

Rationale: The correct answer is C. This is the only behavior that goes against ethical practice in this scenario. The charge nurse should recognize the need for further education when a nurse incorrectly explains that a DNR order includes withholding comfort measures, as this is inaccurate information. Justification for other choices: A is incorrect because it shows compassionate care. B is incorrect because it demonstrates appropriate pain management for a terminally ill client. D is incorrect because nurses have the right to refuse participation in procedures that go against their beliefs.

Correct Answer: B,C

Rationale: The correct answers are B and C. Option B, an oxygen tank, is essential for providing supplemental oxygen if the client experiences any respiratory distress at home. Option C, an obturator, is crucial for reinserting the tracheostomy tube if it accidentally dislodges.
Pipe cleaners (
A) are not necessary for tracheostomy care. Cotton balls (
D) can leave fibers behind and are not recommended. Petroleum jelly (E) can cause aspiration if applied near the stoma.

Correct Answer: C

Rationale: The correct answer is C: Return unused supplies from the bedside to the unit's supply stock. This action helps reduce waste by ensuring that supplies are not being unnecessarily discarded. By returning unused supplies, the unit can minimize unnecessary expenditures on restocking items that could have been used if properly managed. Additionally, it promotes efficient resource utilization and cost savings by preventing duplicate purchases.

Incorrect choices:
A: Using clean gloves rather than sterile gloves for colostomy care may compromise patient safety and increase the risk of infection.
B: Storing opened bottles of normal saline in a refrigerator for up to 48 hours may lead to contamination and compromise patient safety.
D: Waiting to dispose of sharps containers until they are completely full may increase the risk of needle-stick injuries and pose safety hazards.

Correct Answer: B

Rationale: The correct answer is B: As the health care surrogate, the client's partner can make this decision. The rationale for this is that a health care surrogate is legally designated to make medical decisions on behalf of an incapacitated individual. In this case, since the client is unconscious, the partner's wishes as the surrogate should be followed.


Choice A is incorrect because involving the nursing supervisor to review advance directives is not necessary when a designated surrogate is involved.
Choice C is incorrect as contacting the provider is not relevant when the surrogate has the legal authority to make decisions.
Choice D is also incorrect as involving the ethics committee is not necessary when a surrogate has the authority to make decisions.

Correct Answer: A

Rationale: Correct answer: A


Rationale: The nurse's responsibility in the informed consent process is to assess the client's understanding after the provider has discussed the procedure with the client. This step ensures that the client has comprehended the information provided by the provider, clarifies any uncertainties, and confirms the client's voluntary agreement to the procedure. It is crucial for the nurse to confirm the client's understanding to uphold the principles of autonomy and informed decision-making in healthcare.

Summary of other choices:
B: Discussing alternative treatment options is a responsibility of the provider, not the nurse in the informed consent process.
C: Reviewing risks and benefits of the procedure is typically done by the provider during the informed consent process.
D: Placing a photocopy of the signed informed consent in the client's medical record is important but does not directly involve the nurse's role in the informed consent process.