Examkin

Question

Difficulty: Very hardAdvance Directives and Informed Consent

While working in a perioperative unit, a practical nurse (PN) prepares a client for an urgent laparoscopic appendectomy. The surgeon's notes indicate that the risks, benefits, and alternatives of the surgery were discussed with the client earlier in the shift. The charge nurse asks the PN to obtain the client's signature on the consent document. As the PN hands over the pen, the client states, "If the doctor finds cysts on my right ovary during the operation, does signing this give them the right to take it out?" What is the most appropriate action for the PN to take?

  1. A
    Obtain the client's signature since the primary procedure was already discussed, and document the client's ongoing concerns in the nursing notes.
  2. B
    Reassure the client that the consent strictly limits the surgery to the appendix and any additional organ removal would require separate permission.
  3. Withhold the consent document and notify the surgeon that the client requires clarification regarding the specific boundaries of the procedure.Answer
  4. D
    Assess the client's overall understanding of the surgery, and if they appear generally informed, proceed with witnessing the signature.

Answer

Withhold the consent document and notify the surgeon that the client requires clarification regarding the specific boundaries of the procedure.
The correct answer recognizes that the provider performing the procedure holds the legal responsibility to explain its scope, including what actions will be taken if unexpected findings occur. The PN's role is solely to witness the signature of a fully informed client. Because the client has an unresolved question about the medical boundaries of the surgery, the PN must halt the consent process and notify the surgeon.

Step-by-Step Solution

1
Analyze the client's statement to determine their current level of understanding.
The client's question about whether the surgeon can remove additional organs (ovary cysts) indicates a lack of understanding regarding the extent and scope of the scheduled surgery.
Informed consent requires the client to fully comprehend the procedure, including its boundaries and what might happen if unexpected findings occur, before signing.
2
Evaluate the PN's scope of practice concerning informed consent.
The PN is legally permitted to witness the signature and confirm voluntary agreement, but cannot explain medical details, surgical parameters, or assess the depth of competency.
Explaining the specifics of a medical or surgical intervention is strictly the responsibility of the healthcare provider performing the procedure.
3
Determine the appropriate intervention based on the identified knowledge deficit.
The PN must halt the consent process and ensure the surgeon is contacted to address the client's question.
Witnessing the signature of a client who has lingering procedural questions is legally invalid; the provider must clarify before the process continues.

Key Concept

The PN's role in informed consent is limited to witnessing the client's signature and ensuring voluntary agreement. Any questions regarding the medical procedure's scope must be directed to the healthcare provider.
Estimated Time:1m 30s
Rate this question

Topics

Advance Directives and Informed Consent

More questions from this topic