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Difficulty: Very hardInformed Consent

A 17-year-old legally married client presents to the emergency department with a ruptured ectopic pregnancy. The client received intravenous fentanyl 15 minutes ago for severe abdominal pain and is currently lethargic but oriented. The operating provider determines that emergency laparoscopic surgery is required immediately. The client's parents and 18-year-old spouse are present in the waiting room. Which of the following nursing actions regarding informed consent are appropriate in this situation? Select all that apply.

  1. Withhold having the client sign the surgical consent form due to the recent opioid administration.Answer
  2. Identify the client's 18-year-old spouse as the legally authorized surrogate decision-maker.Answer
  3. C
    Inform the client's parents that they must sign the consent form because the client is under 18 years of age.
  4. D
    Explain the surgical risks, benefits, and alternative treatments to the spouse prior to obtaining the signature.
  5. E
    Invoke implied emergency consent and bypass surrogate authorization since the condition is life-threatening.
  6. Witness the spouse's signature on the consent form after the operating provider completes the disclosure discussion.Answer

Answer

The correct actions are to withhold the client's signature due to recent opioid administration, identify the spouse as the legal surrogate, and witness the spouse's signature after the provider's explanation.
The correct actions reflect the integration of several legal concepts: the client is chemically impaired from recent IV fentanyl and cannot sign; her marriage makes her an emancipated minor, meaning her spouse (not her parents) is the legal surrogate; and the nurse's role is strictly to witness the signature after the provider explains the procedure.

Step-by-Step Solution

1
Assess the client's legal competency to sign the consent form.
The client received IV fentanyl 15 minutes ago and is lethargic, rendering her legally incompetent to sign the document.
Central nervous system depressants impair judgment, making the client temporarily unable to provide legally binding voluntary consent.
2
Determine the appropriate legal surrogate decision-maker.
The 18-year-old spouse is identified as the legally authorized surrogate.
Although the client is 17, her married status makes her an emancipated minor. Therefore, her parents lose guardianship, and her spouse becomes the legal next-of-kin.
3
Determine the appropriate scope of practice for the registered nurse regarding the consent process.
The nurse will witness the surrogate's signature after the operating provider explains the procedure.
The provider must explain the risks and benefits; the nurse only witnesses the signature and ensures the surrogate understands.
4
Evaluate if implied emergency consent applies.
Implied consent is not appropriate in this exact moment.
Implied emergency consent is reserved for situations where a surrogate is unavailable. The spouse is present in the waiting room and can provide immediate consent.

Key Concept

Informed Consent: Emancipated Minors, Impaired Competency, and Nurse Scope of Practice
Estimated Time:2m 0s
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Informed Consent

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