Informed Consent Participation
Help Questions
NCLEX-PN › Informed Consent Participation
A client who signed a consent form for a colonoscopy tells the practical nurse (PN), "I'm not sure why I need this test, but the doctor said I should have it." What is the most appropriate action for the nurse to take?
Document the client's statement in the medical record as the only action.
Reinforce the information about the colonoscopy that was previously provided.
Reassure the client that the test is routine and important.
Notify the registered nurse (RN) or healthcare provider of the client's statement.
Explanation
The client's statement indicates a lack of understanding, which may invalidate the consent. The PN's responsibility is to report this immediately to the RN or healthcare provider. The provider must then reassess the client's understanding before the procedure can proceed. Reassuring the client (A) dismisses their concern. Reinforcing information (B) is not appropriate when the client lacks a basic understanding. Documentation (C) is necessary, but immediate communication is the priority action.
A client is scheduled for surgery in two hours. The practical nurse (PN) notes the client received an opioid analgesic 30 minutes ago. The surgeon arrives to obtain informed consent. Which action should the nurse take?
Ask the client to explain the procedure in their own words.
Witness the client's signature on the consent form.
Inform the surgeon that the client recently received an opioid.
Allow the family member at the bedside to sign the consent form.
Explanation
Opioid analgesics can alter a client's cognitive function and ability to make an informed decision. The nurse has a duty to report the recent administration of this medication to the surgeon, who must then determine if the client is competent to provide consent. Witnessing the signature (A) would be inappropriate. While asking the client to explain the procedure (C) is a part of assessing understanding, the presence of the medication is the key issue to report. A family member (D) cannot sign unless they have legal authority (e.g., healthcare power of attorney).
The practical nurse (PN) is preparing a client who speaks only Spanish for a procedure. The consent form is in English. The client's adult child, who is bilingual, offers to interpret. What is the nurse's best action?
Postpone the procedure until the client can understand English.
Notify the RN to obtain a hospital-approved medical interpreter.
Use a translation app on a hospital tablet to communicate with the client.
Allow the adult child to interpret the consent form for the client.
Explanation
To ensure accurate and unbiased communication for informed consent, a hospital-approved medical interpreter is required. Family members may not be proficient in medical terminology or may have personal biases that affect their interpretation. A translation app is not a substitute for a qualified live interpreter in a consent situation. The PN's role is to recognize this need and report it to the RN so the proper resource can be obtained.
A 16-year-old client requires an emergency appendectomy. The client's parents are divorced and cannot be reached. Which action is appropriate for obtaining consent?
A hospital administrator must be contacted to provide consent.
The surgery must be delayed until a legal guardian is contacted.
The surgeon can proceed with the surgery under implied emergency consent.
The client can sign the consent form because they are old enough to understand.
Explanation
In a life-threatening emergency, when the person authorized to give consent is unavailable, the law allows healthcare providers to proceed with necessary treatment under the principle of implied consent. It is assumed a reasonable person would consent to save their life. A 16-year-old is a minor and cannot consent for major surgery unless emancipated (B). A hospital administrator does not have legal authority to consent (C). Delaying life-saving surgery would be negligent (D).
The healthcare provider needs to obtain telephone consent for an emergency procedure for a client who is confused. The client's designated healthcare proxy is on the phone. According to typical hospital policy, which action is required?
Proceed with the procedure based on the provider's verbal confirmation of consent.
Document the telephone consent with a second licensed nurse as a witness on the call.
Have the healthcare proxy come to the hospital to sign the form immediately.
Record the phone conversation to be attached to the client's medical record.
Explanation
Standard procedure for telephone consent requires two licensed healthcare professionals to listen to the verbal consent given by the authorized person. Both individuals then sign the consent form, documenting that consent was obtained via telephone. This ensures verification. Requiring the person to come to the hospital (A) could cause a dangerous delay in an emergency. Recording the call (C) is not standard practice and has privacy implications. The provider's word alone (D) is insufficient without proper witnessing and documentation.
The practical nurse (PN) is preparing a client for a procedure. The client, who has already signed the consent form, asks, "Is there any other option besides this surgery?" What is the nurse's best initial action?
State that you are not authorized to discuss alternative treatments.
Notify the surgeon that the client has questions about alternatives.
Inform the client that it is too late to consider other options now.
Reinforce the benefits of the surgery as explained by the doctor.
Explanation
A discussion of alternatives is a key element of informed consent. If the client is questioning this after signing, it suggests they may not have fully understood this aspect. The PN must notify the surgeon, who is responsible for discussing treatment options with the client. Telling the client it's too late (A) is incorrect and violates their right to withdraw consent. Reinforcing benefits (B) does not address the client's specific question. While stating you're not authorized is true (C), the proactive and correct action is to get the person who is authorized to speak with the client.
An 80-year-old client with advanced dementia needs to have a gastrostomy tube placed. The client is unable to provide consent. The practical nurse should check the client's medical record for which document to identify the legal decision-maker?
An admission agreement.
A living will.
A durable power of attorney for health care.
A do-not-resuscitate (DNR) order.
Explanation
A durable power of attorney for health care (also known as a healthcare proxy or surrogate) is a legal document that designates a specific person to make medical decisions on the client's behalf when they are incapacitated. A living will (A) typically outlines wishes for end-of-life care. A DNR (B) is specific to resuscitation efforts. An admission agreement (D) is an administrative document.
The practical nurse (PN) enters the room of a client scheduled for a biopsy. The client is confused, disoriented to time and place, and does not recognize family members. The consent form was signed yesterday when the client was alert and oriented. Which action should the nurse take?
Document the confusion and re-orient the client to person, place, and time.
Ask the client's spouse at the bedside to co-sign the consent form.
Proceed with procedure preparation since consent was obtained when the client was competent.
Notify the RN of the client's change in mental status before the procedure.
Explanation
A client must be competent at the time of the procedure, not just at the time of signing the consent. A significant change in mental status may invalidate the previously obtained consent. The PN's responsibility is to report this critical change to the RN, who will then inform the provider. The provider must then reassess the client's capacity and determine the next steps (e.g., postponing, seeking consent from a legal proxy). Proceeding (A) is unsafe. The spouse cannot sign unless they have legal authority (B). Re-orienting the client (D) is a good intervention, but reporting the change is the priority action regarding the procedure.
An unconscious client is brought to the emergency department with a life-threatening injury. No family is present. Surgery is required immediately to save the client's life. How is consent for treatment managed in this scenario?
Two physicians must agree on the need for surgery and sign the consent.
The procedure is delayed until next-of-kin can be contacted.
The on-call hospital administrator must provide consent.
Consent is implied due to the emergency nature of the situation.
Explanation
In a true medical emergency where a delay in treatment would cause serious harm or death and the client is unable to consent, consent is implied. The law operates on the assumption that a reasonable person would consent to life-saving treatment. While two physicians may consult on the medical necessity (C), this is not a substitute for consent. The hospital administrator (B) does not have authority to consent. Delaying treatment (D) would be negligent.
A 15-year-old client comes to a clinic seeking treatment for a sexually transmitted infection (STI). The client asks the nurse not to tell their parents. In most states, what is the nurse's best action?
Contact the parents to obtain verbal consent for the client's treatment.
Recognize that minors can consent to STI treatment and proceed with care.
Inform the client that parental consent is required for all treatment of minors.
Explain that the parents' insurance might be billed, revealing the visit.
Explanation
Most states have laws that allow minors to consent to specific types of confidential healthcare without parental notification. These typically include treatment for STIs, substance abuse, and mental health services. Therefore, the nurse should recognize this legal exception and proceed with providing care. Stating parental consent is always required (A) is incorrect. Contacting the parents (D) would violate the minor's right to confidential care in this situation. While insurance billing (B) is a valid practical consideration to discuss with the client, it does not change the legality of their consent.