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Difficulty: HardLegal Rights and Responsibilities

A 72-year-old client is scheduled for an elective cardiac catheterization. The client signed the informed consent document earlier in the day after a comprehensive discussion with the cardiologist. The registered nurse (RN) administers the prescribed preoperative sedation consisting of intravenous midazolam and fentanyl. Fifteen minutes later, while visibly drowsy but easily arousable, the client states, "I have changed my mind. I do not want them to put any wires in my heart. Cancel the procedure." Which is the priority legal and professional action by the RN?

  1. Halt the preoperative preparation, remain with the client, and immediately notify the cardiologist of the client's statement.Answer
  2. B
    Delegate an unlicensed assistive personnel (UAP) to remain at the bedside while physically locating the cardiologist to report the refusal.
  3. C
    Document the statement as expected medication-induced delirium commonly seen in older adults and proceed with the planned transport.
  4. D
    Reassure the client that the consent form is already legally binding and remind them of the procedural benefits discussed previously.

Answer

The RN must halt the preoperative preparation, remain with the client, and immediately notify the cardiologist of the client's statement.
Clients have the legal right to refuse treatment or withdraw previously given consent at any time. Even though the client has received sedation (which impairs the ability to grant new consent), an expression of refusal must always be taken seriously. Proceeding with an invasive procedure after a client has verbally refused, regardless of their sedation level, constitutes medical battery. The nurse's duty is to advocate for the client, halt the procedure, and immediately inform the healthcare provider so they can assess the situation.

Step-by-Step Solution

1
Evaluate the client's statement regarding the upcoming procedure.
The client explicitly stated a desire to cancel the procedure, which constitutes a withdrawal of consent.
Recognizing verbal withdrawal of consent is critical to preventing unauthorized medical procedures (battery).
2
Analyze the impact of the administered preoperative sedation on the client's legal rights.
Although sedation impairs the capacity to give initial consent, a medicated client's explicit refusal or withdrawal of consent must still be honored and investigated.
A client does not lose the right to bodily autonomy or the right to refuse simply because a narcotic or benzodiazepine was administered.
3
Determine the safest and most legally sound nursing intervention.
The RN stops the progression toward surgery, ensures client safety by remaining at the bedside, and escalates the issue to the physician.
The operating provider must be notified to evaluate the client, formally address the withdrawal of consent, and cancel or postpone the procedure.

Key Concept

Withdrawal of Informed Consent and Client Advocacy
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Topics

Legal Rights and Responsibilities

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