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Question

Difficulty: HardInformed Consent

A registered nurse (RN) enters a preoperative staging area to witness the surgical consent signature for a 65-year-old client scheduled for a pacemaker insertion. The client's spouse and an unlicensed assistive personnel (UAP) are present. The RN notes the client is acutely lethargic and disoriented, which the spouse reports began shortly after the client received a preoperative dose of intravenous midazolam. The surgeon is waiting to proceed and requests the RN to witness the signature immediately so the surgical schedule is not delayed. Which actions by the RN are appropriate in this situation? (Select all that apply.)

  1. Intervene to halt the signing process, as the recent administration of a sedative temporarily impairs the client's legal capacity.Answer
  2. Verify the medical record to determine if the spouse is the legally designated healthcare surrogate.Answer
  3. Ensure the surgeon has discussed the procedural risks, benefits, and alternatives with the authorized surrogate.Answer
  4. D
    Document the disorientation as a normal physiological manifestation of aging and proceed with witnessing the signature.
  5. E
    Delegate the assessment of the client's current level of comprehension to the UAP.
  6. F
    Encourage the client to sign by stating, 'Why are you hesitating? Everything will be perfectly fine.'

Answer

The nurse should halt the signing process due to the client's impaired capacity from sedation, verify if the spouse is the designated surrogate, and ensure the surgeon informs the surrogate.
Informed consent requires the client to be competent and acting voluntarily. A client who has received a preoperative sedative like midazolam lacks the legal capacity to sign. The nurse must act as an advocate by halting the process, verifying if the spouse is the legally designated surrogate, and ensuring the surgeon fulfills their duty to explain the risks and benefits to that surrogate.

Step-by-Step Solution

1
Assess the client's capacity to give legal consent.
The client is found to be acutely lethargic and disoriented after receiving intravenous midazolam.
Clients who have received central nervous system depressants or sedating medications are legally considered incompetent to provide valid informed consent.
2
Intervene to prevent the client from signing the document.
The consent process is immediately halted despite the surgeon's request to proceed.
The RN acts as a client advocate to protect the client's legal rights and prevent an invalid consent from being executed.
3
Identify an authorized surrogate decision-maker.
The RN checks the medical record for advance directives or a medical power of attorney.
When a client temporarily lacks capacity, informed consent must be obtained from their legally designated healthcare proxy or surrogate.
4
Verify that the provider has properly informed the surrogate.
The RN ensures the surgeon discusses the procedure with the designated surrogate prior to signature.
The provider is legally responsible for explaining the risks, benefits, and alternatives to the person providing consent.

Key Concept

The registered nurse acts as a client advocate during the informed consent process by assessing cognitive capacity, preventing signatures under the influence of sedatives, and ensuring the provider obtains consent from a legally authorized surrogate.
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Topics

Informed Consent

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