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Difficulty: HardClient Rights and Advocacy

With exactly thirty minutes remaining before a scheduled total joint arthroplasty, a charge nurse directs the practical nurse (PN) to secure a client's signature on the surgical consent form. Upon speaking with the client, the PN discovers that the client is unsure which joint is being operated on, and the attending surgeon has not yet visited the unit to discuss the procedure. Which action should the PN prioritize?

  1. A
    Provide a comprehensive explanation of the arthroplasty procedure to resolve the client's confusion before obtaining their signature.
  2. B
    Accept the charge nurse's directive by independently verifying the correct surgical site in the medical record and instructing the client to sign.
  3. Decline to obtain the signature and notify the charge nurse that the surgeon must first consult with the client to explain the procedure.Answer
  4. D
    Discuss the client's confusion with the surgical coordinator at the main public nurses' station while unauthorized visitors are present.

Answer

Decline to obtain the signature and notify the charge nurse that the surgeon must first consult with the client to explain the procedure.
The practical nurse acts as a client advocate by ensuring the client's right to informed consent is protected. The nurse's role in informed consent is to witness a signature voluntarily given by a competent, fully informed client. Because the surgeon has not explained the procedure or verified the surgical site with the client, true informed consent cannot be obtained. The PN must decline the inappropriate delegation from the charge nurse and advocate for the surgeon to fulfill their legal obligation.

Step-by-Step Solution

1
Assess the client's understanding of the pending surgical procedure.
The client expresses confusion about the surgical site and states the surgeon has not yet visited.
Validating comprehension is a critical prerequisite before a client can provide valid, legal informed consent.
2
Identify the boundaries of the practical nurse's scope of practice regarding informed consent.
The PN recognizes that their role is solely to witness the signature, while the provider is legally responsible for explaining the procedure and verifying the site.
Operating within scope prevents legal liability and ensures the client receives accurate medical information directly from the performing provider.
3
Advocate for the client's right to true informed consent by escalating the issue.
The PN refuses the inappropriate delegation and insists the surgeon consult the client.
Client advocacy requires intervening when care protocols, such as informed consent, are bypassed or rushed.

Key Concept

Client Advocacy and Informed Consent Roles
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Topics

Client Rights and Advocacy

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