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Difficulty: MediumInformed Consent

A nurse is caring for an older adult client who is scheduled for an elective bronchoscopy. Twenty minutes ago, the client was administered a prescribed dose of intravenous lorazepam to manage severe preoperative anxiety. The pulmonologist just arrived at the bedside and requests that the nurse witness the client signing the informed consent document. Which of the following actions should the nurse take? (Select all that apply)

  1. Notify the healthcare provider that the client's current medication status precludes giving legal authorization.Answer
  2. Collaborate with the healthcare provider to contact the client's legally designated surrogate decision-maker.Answer
  3. Ensure the planned procedure is placed on hold until valid authorization is legally secured.Answer
  4. D
    Attribute any mild cognitive clouding to the client's advanced age and permit the provider to obtain the signature.
  5. E
    Ask the unlicensed assistive personnel (UAP) to go over the procedural risks with the client while the nurse reviews the chart.
  6. F
    Encourage the client to sign quickly by saying, 'This is a very routine test and you have absolutely nothing to worry about.'

Answer

The correct actions are to notify the provider that the client cannot legally sign, collaborate to contact the designated surrogate decision-maker, and place the procedure on hold until valid consent is secured.
Informed consent requires the client to be voluntarily willing and cognitively competent to understand the risks, benefits, and alternatives of a procedure. Because the client recently received intravenous lorazepam (a sedative), they are considered legally and pharmacologically incompetent to provide valid consent. The nurse acts as a client advocate by stopping the signature process, informing the provider of the medication status, initiating contact with the legal surrogate decision-maker, and ensuring the procedure does not proceed without authorized consent.

Step-by-Step Solution

1
Analyze the client's physiological and legal status.
The client received intravenous lorazepam 20 minutes ago.
Lorazepam is a central nervous system depressant that alters cognition, rendering the client legally incompetent to sign an informed consent document.
2
Determine the appropriate nursing intervention for client advocacy.
The nurse must intervene to prevent the client from signing the document.
The nurse is legally obligated to advocate for the client and ensure that consent is only given voluntarily by a competent individual.
3
Identify the correct legal steps to obtain valid consent.
The medical power of attorney or surrogate must be contacted.
When a client is temporarily incompetent for an elective procedure, informed consent must be deferred to their legally authorized representative.

Key Concept

Clients who have received sedative, analgesic, or mind-altering medications cannot legally provide informed consent. The nurse must act as an advocate by stopping the consent process and directing the provider to the legally authorized surrogate.
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Informed Consent

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