Examkin

Question

Difficulty: Very hardInformed Consent

An 82-year-old conscious, intubated client in the intensive care unit is scheduled for a bedside tracheostomy. The client has bilateral soft wrist restraints in place to prevent accidental extubation. Earlier, the healthcare provider explained the procedure, and the client nodded in agreement. Because the client was unable to sign the consent form, the provider obtained telephone consent from the client's legally designated healthcare proxy. As the provider prepares the sterile field, the client's heart rate elevates to 135 bpm, and the client vigorously shakes their head 'no' while attempting to push the provider's hands away with their elbows. Which action should the nurse take first?

  1. A
    Attempt to calm the client by explaining that the legally designated proxy has already authorized this beneficial procedure.
  2. B
    Administer a prescribed as-needed intravenous sedative to suppress the combative behavior and allow the procedure to proceed.
  3. Halt the procedural setup and advocate for the client by stating they are actively indicating a refusal of the treatment.Answer
  4. D
    Document the agitation as normal age-related cognitive decline and instruct the client to lie still for the provider.

Answer

The nurse's priority is to halt the procedural setup and advocate for the client by stating they are actively indicating a refusal of the treatment.
The core principle of informed consent is that a conscious client retains the right to refuse or revoke consent at any time before a procedure begins. Even though the healthcare proxy provided telephone consent because the client physically could not sign, the client's current non-verbal actions clearly indicate a revocation of that consent. The nurse's primary duty as an advocate is to halt the procedure and ensure the client's immediate refusal is respected, preventing potential battery.

Step-by-Step Solution

1
Analyze the client's legal status and capacity to consent or refuse.
The client is conscious, and despite having a proxy consent on file due to a physical inability to sign, the client retains the fundamental right to revoke consent.
A competent, conscious client's immediate wishes always supersede a proxy's previous authorization.
2
Interpret the client's non-verbal communication.
Head shaking and pushing away actively demonstrate a revocation of the prior implied and proxy agreement.
Intubated and physically restrained clients must rely entirely on non-verbal cues to exercise their legal rights.
3
Determine the priority nursing intervention.
The nurse must immediately intervene to stop the provider from continuing.
The nurse acts as the client's advocate to prevent a procedure from occurring against the client's active refusal, which would legally constitute battery.

Key Concept

The right of a conscious client to revoke informed consent at any time prior to a procedure, even non-verbally, supersedes a surrogate's prior authorization.
Rate this question

Topics

Informed Consent

More questions from this topic