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Difficulty: Very hardClient Rights and Advocacy

A practical nurse (PN) is assigned to care for an emancipated 17-year-old client who is 32 weeks pregnant and receiving observation for gestational hypertension. The client's parent arrives at the unit, states they provide the client's medical insurance, and demands to review the client's electronic health record. Simultaneously, the client tells the PN, "I refuse to take the blood pressure medication, and I am leaving the hospital right now." Which actions should the PN take? (Select all that apply.)

  1. Inform the parent that they cannot view the medical record without the client's explicit authorization.Answer
  2. B
    Provide detailed clinical counseling regarding the risks of untreated gestational hypertension so the refusal is legally informed.
  3. C
    Disclose the client's recent elevated blood pressure readings to the parent to enlist their help in persuading the client to stay.
  4. Notify the prescribing healthcare provider immediately regarding the medication refusal and the client's intent to leave against medical advice.Answer
  5. Document the client's exact verbal statements regarding the medication refusal and desire to leave in the health record.Answer
  6. F
    Apply a bed alarm and instruct unlicensed assistive personnel to physically block the client if they attempt to exit the unit.

Answer

The correct actions are to inform the parent that authorization is required to view the medical record, notify the healthcare provider of the refusal and intent to leave, and accurately document the client's exact statements.
Emancipated minors hold full adult rights regarding healthcare decisions and privacy. The practical nurse must advocate for these rights by protecting the client's medical record from unauthorized access by the parent. When facing a refusal of treatment and a desire to leave against medical advice, the PN operates within their scope by immediately notifying the healthcare provider and carefully documenting the client's exact words. The PN facilitates communication rather than forcing compliance.

Step-by-Step Solution

1
Determine the client's legal status and privacy rights.
The client is an emancipated minor, meaning they possess the same legal rights as an adult, including full HIPAA protections against unauthorized disclosure to parents.
This establishes that the parent has no legal authority over the client's care or access to their health information.
2
Evaluate the practical nurse's scope of practice regarding treatment refusal.
The PN must withhold the medication, notify the provider, and document the event, but must not take on the provider's role of conducting informed refusal counseling.
Primary teaching and advanced clinical counseling fall outside the legal scope of practice for a PN.
3
Assess the legality of preventing the client from leaving.
The client has the right to leave against medical advice (AMA); physical or chemical restraint to prevent departure is illegal.
Preventing a legally competent adult or emancipated minor from leaving a facility constitutes false imprisonment.

Key Concept

Client Rights, Advocacy, and Scope of Practice for the Practical Nurse
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Topics

Client Rights and Advocacy

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