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Difficulty: HardAdvance Directives and Informed Consent

While monitoring a client on a telemetry step-down unit, a practical nurse (PN) notes the client is holding an unsigned procedural agreement for a scheduled pacemaker insertion. The client remarks, "The doctor explained everything, but I am suddenly worried that having this device goes against the wishes written in my Living Will." Which responses by the practical nurse are legally and professionally appropriate? (Select all that apply)

  1. Postpone acting as a witness to the client's signature until the provider has addressed the new concerns.Answer
  2. Report the client's conflict between the procedure and their advance directive to the supervising registered nurse.Answer
  3. C
    Elaborate on the medical risks and benefits of the pacemaker to help alleviate the client's sudden anxiety.
  4. D
    Analyze the text of the Living Will to determine if a pacemaker qualifies as an artificial life-sustaining treatment.
  5. E
    Advise the client that their durable power of attorney for healthcare must now sign the document on their behalf.

Answer

The appropriate actions are to postpone witnessing the client's signature and to report the client's conflict to the supervising registered nurse.
The legal role of the practical nurse in informed consent is limited to verifying the client's identity, ensuring they are signing voluntarily, and acting as a witness. When a client expresses uncertainty about a procedure or its alignment with an advance directive, the correct action is to halt the signing process and escalate the concern to the registered nurse or healthcare provider for further clarification.

Step-by-Step Solution

1
Analyze the client's statement and current situation.
The client is competent but expressing new doubts about whether the scheduled procedure aligns with their advance directive.
Identifying the client's competency and level of understanding dictates who can sign the form and whether informed consent has truly been achieved.
2
Determine the legal boundaries of the practical nurse's role in this scenario.
The PN can only witness signatures when the client is fully informed and willing. The PN cannot explain the procedure or interpret legal documents.
Adhering to scope of practice protects the client's rights and prevents the nurse from practicing medicine or advanced nursing without authorization.
3
Select the interventions that protect the client and follow the chain of command.
The PN must stop the consent process and escalate the client's concerns to the RN or provider for resolution.
Escalation ensures the provider fulfills their legal duty to obtain true informed consent before any intervention occurs.

Key Concept

Advance Directives and Informed Consent
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Topics

Advance Directives and Informed Consent

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