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Difficulty: MediumInformed Consent

A 71-year-old client on a surgical unit is preparing for a bowel resection later today. The client received an intravenous (IV) dose of morphine 45 minutes ago to manage acute abdominal pain. The healthcare provider has asked the registered nurse (RN) to witness the client's signature on the informed consent document. Upon entering the room, the client states, "I am willing to have the surgery, but I honestly do not remember what other options the doctor discussed with me." Which actions should the RN take? Select all that apply.

  1. Notify the healthcare provider that the client requires further explanation regarding the alternative treatments.Answer
  2. Inform the healthcare provider that the client is currently unable to legally sign the consent form due to recent opioid administration.Answer
  3. Document the client's statements and the subsequent notification of the healthcare provider in the electronic health record.Answer
  4. D
    Explain the surgical alternatives to the client to ensure adequate comprehension before obtaining the signature.
  5. E
    Attribute the client's memory lapse to normal age-related cognitive changes and proceed with witnessing the signature.
  6. F
    Delegate the task of witnessing the consent signature to an unlicensed assistive personnel (UAP) after the client's questions are answered.

Answer

The correct actions include notifying the healthcare provider that the client needs further explanation about alternatives, informing the provider that the client cannot legally sign due to recent opioid administration, and documenting these events in the medical record.
The RN must notify the healthcare provider because explaining surgical alternatives is the provider's responsibility. Furthermore, the client received IV morphine 45 minutes ago, making them chemically impaired and legally unable to sign a consent form. All of these observations and notifications must be thoroughly documented in the electronic health record to maintain a legal account of the client's care.

Step-by-Step Solution

1
Assess the client's competency and understanding of the procedure.
The client lacks understanding of the surgical alternatives and is under the influence of an opioid analgesic.
To validate that the consent is truly informed, voluntary, and given by a legally competent individual.
2
Identify the appropriate nursing interventions based on the assessment.
The RN must halt the consent process, notify the healthcare provider of both the knowledge deficit and the chemically impaired capacity, and document the findings.
The RN acts as a client advocate, ensuring legal and ethical standards are met before an invasive procedure.

Key Concept

Informed Consent
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Topics

Informed Consent

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