A 75 year old mentally competent man is suffering from a rectal cancer that requires surgery. His sonsand brothers bring the reports to a surgeon to confirm diagnosis and discuss the treatment plan. Theyplead with the surgeon not to tell the patient about the diagnosis of cancer and to proceed with surgerywhich involves colon resection and temporary colostomy, followed by reversal. They are willing to signall consent documents.How should the surgeon proceed?Who should sign the informed consent?What is the requirement in Pakistan law?

Who among the following patients can sign their own informed consent?*1 pointA. A 17-year old prodigy who graduated as summa cum laudeB. A 25-year old man who cannot speakC. A 90-year old woman who is on life saving medicationsD. A 37-year old intoxicated chief of surgery152. You are reviewing the charts of your patient who is to undergo appendectomy later today. Which among the following chart entries will alert you to call their surgeon?*1 pointA. A nothing-per-orem order since 12:00 MNB. A signed informed consentC. Medications include: phenothiazine, vancomycin, and atropine sulfateD. Medical history of taking multivitamin supplements containing vitamins A, C, D, B complex, and gingko biloba.153. Who among the following members of the surgical team is deemed to be following the principles of asepsis?*1 pointA. A circulating nurse who is preparing the mayo tableB. A circulating nurse who is wearing her surgical cap in the wardC. A surgeon who only wears their mask inside the OR theatreD. A scrub nurse who prefers wearing scrubs one size smaller to prevent breaks in asepsis154. 8 hours post-operation, a patient in the PACU suddenly presents with new-onset disorientation, began pulling her IV lines, and screams at the nurse for trapping her in the ward. Medical history reveals that the patient has no history of psychiatric illnesses. What is the appropriate nursing action?*1 pointA. Call the surgeon-in chargeB. Put restraintsC. Administer PRN diazepamD. Reorient the client to person, place, and time155. You are monitoring your patient who is admitted to the PACU 1 hour ago and you noted a 4 x 4 cm, bright red drainage on the dressing of the patient’s operative site. What is your appropriate initial action?*1 pointA. Inspect the wound to get further assessment dataB. Document findings and continue monitoringC. Call the surgeon-in-chargeD. Check the patient’s platelet count156. Your 75-year old post-cholecystectomy patient asks you why you keep on insisting that they walk around the unit. You will answer that the benefits of early ambulation includeI.         Preventing postoperative pneumoniaII.         Preventing postoperative atelectasisIII.         Preventing development of deep vein thrombosisIV.         Preventing development of deliriumV.         Preventing development of postoperative ileusVI.         Preventing development of contractures*1 pointA. I, III, V, VIB. I, II, III, V, VIC. III, IV, V, VID. All of the above157. What intervention written by your staff nurse for a patient who is at risk for developing deep vein thromboembolism will alert you to intervene?*1 pointA. Ensuring activity by asking the patient to dangle the legs before getting out of bed to walkB. Using thigh-high anti-embolism stockingsC. Administering low-dose heparin, as scheduledD. Giving 2500 mL of fluids per day158. A patient who is admitted to the PACU 2 hours ago suddenly presses the call button stating that she vomited. You went to the bedside and confirmed that the patient vomited. What is your initial nursing action?*1 pointA. Elevate the head of bed to semi-Fowler’sB. Assess the patient’s abdomenC. Administer PRN antiemeticsD. Call the surgeon in-charge

A 28year old man presents to casualty with testicular torsion and in extreme pain. He is scheduled for emergency surgery and the consultant urologist tells you he is on his way and will be there in the next one hour. He asks you not to give any pain medication so that “consent can be obtained” on his arrival. Are the surgeons concerns about informed consent valid?Question 36Select one:a.Because of severe pain, the surgeon’s concerns are not valid as it can impair a patient’s ability to listen and understand in the informed consent process.b.It’s an emergency you do not need informed consent in this casec.None of the choices apply.d.Yes. Because hospital policy requires informed consent from a lucid person before surgerye.Yes. To obtain informed consent the patient must be lucid and pain medication can invalidate the consent

15. The perioperative nurse’s primary responsibility in the process of informed consent is:*1 pointA. Discuss possible complications of proposed procedureB. Provide the client with details of proposed surgical procedureC. Ensure that the anesthetist/anaesthesiologist has met with the patient before the procedureD. Advocate patient to ensure that the client is given necessary information to give consent16. Nurses assume complementary and shared responsibilities in decision making and problem solving relevant to patient care. In such situation, the nurse is performing the proactive role of being a:*1 pointA. CaregiverB. CommunicatorC. AdvocateD. Collaborator17. This role of nurses in healthcare involves implementing interventions that help overcome resistance and facilitate positive growth and development:*1 pointA. Change agentB. AdvocateC. CaregiverD. Communicator18. In the discharge of his duties, Nurse Gelo ensures that autonomy and self-determination of the patient are safeguarded. This role of the nurse in healthcare is known as:*1 pointA. CollaboratorB. AdvocateC. Change agentD. Communicator19. Circumstances such as floods, fire earthquakes and accidents falls under this doctrine and nurses who fail to render service during these circumstances are not held negligent.*1 pointA. Res ipsa loquiturB. Force majeureC. Respondeat superiorD. Epikia20. A hospital was found liable for the negligence of its nurses when they failed to adhere to the explicit policy it had established that bedrails were to be raised at all times for a particular category of high-risk patients. What doctrine was used by the court in this civil case?*1 pointA. Res ipsa loquiturB. Force majeureC. Respondeat superiorD. Epikia21. Which situation may lead to a legal action for assault?*1 pointA. A nurse threatens a patient with inserting a tube to feed the patient if the patient does not eat all the food on a meal tray.B. A nurse administers a medication that the patient has refused by telling the patient that it is different than the refused medication.C. A nurse uses a restraint when a patient attempts to leave the hospital before the primary health-care provider writes a discharge order.D. A nurse is heard by a patient’s relative telling another nurse on an elevator that the patient contracted hepatitis C from IV drug use when, in fact, the patient contracted the disease via a blood transfusion.22. The Code of Ethics for Filipino Nurses is promulgated under which resolution?*1 pointA. BON Resolution No. 425, Series of 2003B. BON Resolution No. 220, Series of 2004C. BON Resolution No. 112, Series of 2005D. BON Resolution No. 22, Series of 200923. Lactated Ringer’s Solution is what type of solution?*1 pointA. IsotonicB. HypotonicC. HypertonicD. Isokinetic24. Which of the following is not an isotonic solution?*1 pointA. D5 1/2NSSB. 0.9% NaClC. LRD. D5W25. A client who has had a thoracic surgery has a chest tube connected to a water-seal drainage system attached to suction. When excessive bubbling is identified in the water seal chamber the nurse should:*1 pointA. check the system for air leaksB. “strip” the chest tube catheterC. decrease the amount of suction pressureD. recognize that the system is functioning correctly26. The most accurate parameter to assess a patient's fluid status is:*1 pointA. weightB. temperatureC. blood pressureD. urine output

An adult woman with symptomatic gallstones is brought to the surgeon by her husband. Afterexamination and going over the investigations, the doctor recommends laparoscopic cholecystectomy.Communication is primarily between the husband and the surgeon since he is the only one askingquestions. The RMO brings out the consent form and the husband signs it.What are the ethical and legal issues in this situation?

An unconscious male is brought to the ER by his wife and his brother after a road traffic accident. He isassessed by the neurosurgery team who decide on an emergency craniotomy to evacuate an expandingextradural hematoma.Who gives consent: his brother, the patient’s wife, the physician, or is no consent required in thissituation?What if the patient was brought in by a taxi driver and has no accompanying family/friend?How does the process of informed consent take place?