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Difficulty: MediumInformed Consent

A client is in the preoperative holding area awaiting a scheduled cardiac catheterization. When the nurse brings the informed consent form for the client to sign, the client pushes the clipboard away and states, 'I changed my mind. I am too scared about having a stroke during this test.' Arrange the following nursing actions in the priority order they should be performed. (Place the first required action at the top and the final action at the bottom.)

  1. 1Ask open-ended questions to explore the client's specific fears regarding the procedure.
  2. 2Withhold the administration of the prescribed 'on-call' preoperative sedative.
  3. 3Notify the cardiologist that the client has withdrawn consent and requires further discussion.
  4. 4Document the client's exact statements and the notification of the provider in the medical record.

Answer

The correct priority sequence is to first assess the client's specific fears, then withhold any preoperative sedation, next notify the cardiologist, and finally document the event.
When a client revokes consent or expresses significant doubt, the nurse must follow a logical sequence based on the nursing process and client safety. Assessment comes first to understand the issue. Withholding medication ensures the client remains legally competent. Notifying the provider is required because answering specific risk-related questions is the provider's responsibility. Finally, documentation legally records the sequence of events.

Step-by-Step Solution

1
Assess the client's exact concerns by asking open-ended questions.
The nurse understands the root cause of the client's anxiety and refusal.
The nursing process always begins with assessment. Gathering data ensures subsequent actions are appropriate.
2
Withhold preoperative sedation.
The client remains fully competent and capable of making legal decisions.
Administering sedatives to a client who has expressed doubt or revoked consent would compromise their ability to legally consent if they change their mind after speaking with the provider.
3
Contact the cardiologist.
The healthcare provider is informed of the client's concerns and refusal.
It is outside the registered nurse's scope of practice to explain the medical risks of a surgical procedure. The provider must clarify the risk of stroke with the client.
4
Document the event.
The electronic health record accurately reflects the client's change in status.
Accurate and timely documentation provides a legal record of the client's statements and the nurse's advocacy actions.

Key Concept

Informed Consent Revocation and Priority Setting
Estimated Time:1m 30s
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Topics

Informed Consent

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