Examkin

Question

Difficulty: HardInformed Consent

A 78-year-old client with early-stage Alzheimer's disease is admitted for severe dysphagia. The healthcare provider recommends the surgical placement of a percutaneous endoscopic gastrostomy (PEG) tube and leaves the consent form at the bedside. The client is oriented to person and place, understands they are having trouble swallowing, but firmly states, "I do not want any feeding tubes." The client's adult child, who is not the legally designated healthcare proxy, tells the nurse, "She is confused because of her age and memory loss. Just let me sign the consent so you can do the surgery." Which of the following actions should the nurse take next?

  1. Acknowledge the client's refusal, withhold the consent form, and notify the healthcare provider to assess the client's current decision-making capacity.Answer
  2. B
    Inform the client that severe memory loss is a normal physiological part of the aging process, meaning their adult child must now sign the consent form.
  3. C
    Tell the client that the feeding tube is necessary for survival and ask them why they are refusing a procedure that will help them recover.
  4. D
    Delegate an unlicensed assistive personnel (UAP) to stay at the bedside and educate the client on the benefits of the surgery to encourage their signature.

Answer

Acknowledge the client's refusal, withhold the consent form, and notify the healthcare provider to assess the client's current decision-making capacity.
The nurse must act as a client advocate. A diagnosis of early-stage Alzheimer's disease does not automatically mean the client is legally incompetent to make medical decisions. Because the client is expressing a clear refusal and the adult child does not have legal proxy status (such as a Durable Power of Attorney for Healthcare), the nurse cannot allow the child to override the client's wishes. The correct action is to respect the client's refusal, withhold the form, and notify the healthcare provider, who is responsible for formally evaluating the client's decision-making capacity.

Step-by-Step Solution

1
Analyze the client's cognitive and legal status based on the clinical presentation.
The client has early-stage Alzheimer's but is currently oriented, understands their physical deficit (dysphagia), and clearly articulates a refusal. The adult child is not a designated legal proxy.
Determining who holds the legal right to consent or refuse treatment is the first step in protecting client autonomy.
2
Evaluate the legal requirements for overriding informed consent.
A medical diagnosis of dementia does not automatically render a client legally incompetent. Only a formal medical evaluation or a court can determine incompetence for decision-making.
Nurses must operate within legal frameworks and avoid making assumptions about competency based solely on age or a psychiatric/neurological diagnosis.
3
Identify the appropriate nursing intervention for a client refusing a procedure.
The nurse must act as an advocate, withhold the consent form from the unauthorized family member, and escalate the situation to the healthcare provider.
The healthcare provider is ultimately responsible for evaluating the client's competency to refuse the procedure and discussing further alternatives.

Key Concept

Informed Consent, Client Advocacy, and Competency
Rate this question

Topics

Informed Consent

More questions from this topic