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Question

Difficulty: MediumInformed Consent

An 82-year-old client is scheduled for an elective total knee arthroplasty. When the registered nurse (RN) approaches to witness the informed consent signature, the RN observes that the client is experiencing new, sudden-onset disorientation to time and place. The surgeon states that the client was fully oriented during morning rounds. Which of the following actions should the RN take?

  1. Withhold the consent form and notify the surgeon that the client currently lacks the capacity to provide legal consent.Answer
  2. B
    Allow the client to sign the form, recognizing that intermittent confusion is a normal and expected part of the aging process.
  3. C
    Delegate the task of reorienting the client and obtaining the signature to the unlicensed assistive personnel (UAP).
  4. D
    Tell the client, 'Try to focus and sign this paper so you can have your surgery and feel better,' to provide reassurance.

Answer

Withhold the consent form and notify the surgeon that the client currently lacks the capacity to provide legal consent.
The correct answer demonstrates the RN's responsibility as an advocate and a witness. The RN must confirm that the client is competent and fully understands the procedure before signing. Because the client has developed acute confusion (delirium), they currently lack the legal capacity to consent. The RN must withhold the form and notify the surgeon.

Step-by-Step Solution

1
Assess the client's current cognitive status and ability to provide informed consent.
The client is experiencing sudden-onset disorientation, indicating acute confusion (delirium).
The RN is legally responsible for verifying that a client is competent and volunteering without coercion before witnessing a signature.
2
Determine if the client can legally sign the consent form.
The client cannot legally sign because they currently lack the cognitive capacity to understand the risks, benefits, and alternatives of the procedure.
Informed consent requires the client to be fully oriented and competent at the exact time of signing.
3
Select the appropriate nursing intervention.
The RN must advocate for the client by refusing to witness the signature and notifying the surgeon of the change in mental status.
Notifying the provider ensures the surgery is paused until capacity is regained or an authorized surrogate decision-maker is identified.

Key Concept

The registered nurse must ensure the client is cognitively competent at the time of signing the informed consent document.
Estimated Time:1m 15s
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Topics

Informed Consent

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