Question 1

Your patient is scheduled for a hysterectomy. You ask the patient if her physician has explained the risks and benefits of the surgery and ask if she has any questions. The patient states that she is unclear as to whether her ovaries are to be removed. What should you do?

Accepted Answer

Answer reason: Informed consent requires that the provider performing the procedure explain the risks, benefits, and details of the surgery. If the patient has unanswered questions, the nurse must advocate for the patient by notifying the surgeon to provide clarification before consent is valid. The nurse should not provide incomplete or potentially inaccurate information or delay clarification.

Question 2

The nurse is providing a patient with information about a blood transfusion including potential risk factors and side effects. Which principle of ethics applies to this nursing action?

Accepted Answer

Answer reason: Teaching about transfusion risks and side effects supports informed consent by enabling a voluntary, knowledgeable choice. This aligns most directly with respecting self-determination rather than promising loyalty (fidelity) or focusing on truth-telling as the primary ethical duty (veracity). Justice concerns fairness in distribution of resources and does not specifically address consent education.

Question 3

A 39-year-old is brought into the Emergency Department as a pedestrian hit by a vehicle. Witnesses state the patient was crossing the road, not at a stoplight, and a car making a right turn onto the road hit her at approximately 30 miles per hour. The patient has a right open tibia fracture, dislocated right ankle, and no pedal pulse in the right foot. The patient is screaming “The aliens hit me! The giant spaceship tried to suck me in.” Ambulance personnel report the patient has a known history of schizophrenia. Which of the following is true for this patient?

Accepted Answer

Answer reason: This patient’s statements suggest active psychosis and impaired capacity right now, so consent should be deferred until capacity is restored when clinically feasible. If the situation is limb- or life-threatening and delay risks serious harm (e.g., ischemic limb with absent pedal pulse), treatment may proceed under implied emergency consent rather than using staff or EMS as surrogate signers. The other options are incorrect because nurses/ambulance personnel are not appropriate parties to “sign consent” on behalf of an incapacitated patient, and “alert and oriented” is not the standard—capacity is.

Question 4

A client with a ruptured aneurysm is scheduled for surgery to insert a graft. One hour before the procedure, the client informs the nurse that they have changed their mind. What should the nurse do first?

Accepted Answer

Answer reason: A competent client can withdraw consent at any time, so the nurse’s priority is to assess decision-making capacity and clarify the reason for refusal to ensure the choice is informed and voluntary. This immediate conversation can uncover remediable issues (e.g., uncontrolled anxiety, misunderstanding of risks/benefits, inadequate pain control) and confirms the client’s wishes before escalating. After the client’s intent is verified, the nurse then notifies the surgeon/anesthesia team so the procedure can be halted and alternatives discussed. Documentation is important but follows the priority actions to support the client’s rights and prevent an unintended procedure.

Question 5

Prior to a colonoscopy, which of the following should the nurse verify first?

Accepted Answer

Answer reason: The nurse’s priority is to ensure the patient has legally authorized the procedure after receiving required information, which is a key safety and ethical obligation. IV access and bowel preparation are important pre-procedure checks, but they are not the first priority if consent is not confirmed. A time-out is a critical safety step, but it occurs immediately before the procedure begins rather than as the first pre-procedure verification step.

Question 6

A nurse is caring for a laboring client who is requesting pain relief. The nurse explains the benefits and possible side effects of an epidural, and the client decides to proceed. Which ethical principle is the nurse demonstrating?

Accepted Answer

Answer reason: By explaining the benefits and potential side effects of an epidural, the nurse is providing information needed for an informed, voluntary choice. This communication enables the client to consent based on understanding rather than coercion. Fidelity relates to keeping promises, justice to fairness in resource distribution, and nonmaleficence to avoiding harm, none of which best matches the informed decision-making focus in the stem.

Question 7

A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the nurse should determine whether this method of family planning would be most appropriate?

Accepted Answer

Answer reason: Sterilization is permanent, so determining future reproductive plans is essential to ensure informed decision-making and appropriate consent.

Question 8

You are preparing a child for IV conscious sedation before the repair of a facial laceration. What information should you report immediately to the physician?

Accepted Answer

Answer reason: A parent’s refusal means the procedure cannot legally proceed. This directly affects the ability to perform sedation and requires immediate provider notification to address consent and decision-making.

Question 9

In emergency situation when a patient is unable to give consent for life saving treatment, what type of consent allows us to assume APPROPRIATE medical treatment?

Accepted Answer

Answer reason: This doctrine supports immediate life-saving interventions while respecting autonomy as much as possible in urgent circumstances. Informed consent is the standard for non-emergent care but requires capacity, disclosure, and voluntary agreement, which are not feasible here. Express consent requires a clear verbal or written permission, which the patient cannot provide. The emergency exception is therefore best captured by implied consent.

Question 10

Whose responsibility is it to obtain informed consent?

Accepted Answer

Answer reason: This responsibility cannot be delegated to nursing staff because it requires procedure-specific medical knowledge and the ability to answer detailed questions. The nurse’s role is to verify that consent is completed, assess capacity/voluntariness, witness the signature per policy, and advocate if the client appears uninformed or coerced. An anesthesiologist would obtain consent specifically for anesthesia, but for the overall procedure the performing provider is accountable.

Question 11

A 40-year-old woman is undergoing an elective rhinoplasty under general Anesthesia. The patient is in the pre-operative room and the nurse is prepared to administer pre-operative intravenous medications. The patient states that she does not have any drug allergies. Which additional nursing action is most important priority to administering the medicine?

Accepted Answer

Answer reason: The nurse’s priority is to verify that the provider has explained the procedure, risks, benefits, and alternatives and that the client has voluntarily signed while competent. Administering IV pre-op meds before confirming consent creates a legal/ethical risk and can delay or invalidate the consent process. The other actions may be appropriate pre-op tasks, but they do not supersede ensuring valid consent prior to medications that could alter cognition.

Question 12

The nurse is working with a client admitted with delirium and reduced level of consciousness due to pneumonia and respiratory failure. The nurse anticipates that the client may need to be intubated soon. The client is not able to make decisions. Who will make decisions for the client?

Accepted Answer

Answer reason: A health care proxy (durable power of attorney for health care) is specifically appointed to make health decisions consistent with the client’s known wishes and best interests. The spouse may be next-of-kin in some jurisdictions, but that role is secondary when a proxy has been formally designated. The HCP provides recommendations and performs emergency treatment as permitted, but does not replace the surrogate decision-maker for consent when time allows.

Question 13

The male client had a hemicolectomy. The client is refusing to wear the prescribed sequential compression devices (SCDs). What is most important for the nurse to communicate to the client?

Accepted Answer

Answer reason: After major abdominal surgery, immobility and a hypercoagulable state increase the risk of DVT and pulmonary embolism, and SCDs are a standard nonpharmacologic measure to reduce venous stasis. Communicating the potential for serious harm, including fatal pulmonary embolism, directly addresses the essential risk information needed for informed refusal. Having a refusal form signed and notifying the surgeon are appropriate follow-up actions, but they do not replace the priority teaching needed to support informed decision-making. Billing threats are nontherapeutic and do not meet ethical/legal standards for client education.

Question 14

The nurse is caring for a client with prostate cancer who is scheduled for an orchiectomy. The client states, "I still don't understand why I need this surgery." The nurse should reinforce the preoperative instructions with the client to indicate that the surgery?

Accepted Answer

Answer reason: Orchiectomy is a form of androgen-deprivation therapy that rapidly reduces circulating testosterone produced by the testes. This directly addresses the client’s “why” by explaining the therapeutic goal is hormonal suppression rather than removing the prostate tumor itself. Bone is the most common metastatic site, so the surgery does not eliminate metastasis, and it is not performed to avoid chemotherapy. It also does not remove the primary source of the cancer because the prostate remains in place.

Question 15

Giving intravenous injection without obtaining informed consent from the patient is an example of?

Accepted Answer

Answer reason: Battery is the unconsented touching/procedure itself, while assault is the threat or creation of apprehension of such contact; giving an injection without permission fits this framework. Negligence involves an unintentional breach of the standard of care causing harm, which is not the core issue here. The key legal problem is lack of valid consent for an invasive intervention.

Question 16

An unconscious client is brought to the emergency department by the paramedics after being hit by a car. An emergency craniotomy is required. The client has no identification. What action should be taken next?

Accepted Answer

Answer reason: An emergency craniotomy after traumatic injury is time-critical, so the priority is rapid definitive care rather than administrative steps. Efforts to identify the client or locate a surrogate can occur concurrently but must not delay urgently needed surgery. A court order is not required for emergent, life-saving treatment and would create unsafe delay.

Question 17

The nurse has just received a prescription to transfuse a unit of packed red blood cells for an assigned client. What action should the nurse take next?

Accepted Answer

Answer reason: Blood transfusion is a high-risk therapy that requires verified informed consent before blood products are obtained or administered. Confirming a signed consent ensures the client (or legal representative) received adequate explanation of benefits, risks (e.g., transfusion reaction), and alternatives, meeting legal-ethical standards. Ordering blood or gathering tubing are preparatory steps but should not proceed until consent is verified to avoid delays, waste, and liability. Baseline vital signs are important immediately prior to starting the transfusion, but the priority “next” action after receiving the prescription is to ensure the authorization to proceed is in place.

Question 18

After receiving detailed information about a colonoscopy from the primary health care provider (HCP), the nurse asks the client to sign the informed consent form and discovers that the client cannot write. Which is the best intervention for the nurse to implement?

Accepted Answer

Answer reason: A client who cannot write may still provide legally valid consent if they have decision-making capacity and the procedure has been explained; the issue is documenting the client’s authorization. Allowing the client to make a mark (e.g., an X) with two witnesses supports that the mark was made voluntarily by the client and that the client appeared to understand what they were consenting to. The provider does not need to re-obtain consent solely because the client is unable to write, as long as the provider already completed the required disclosure and the client can consent. Verbal consent alone is typically insufficient when a written consent form is required for an invasive procedure and does not address the documentation requirement.

Question 19

After signing an informed consent form, a client states, “I have changed my mind and do not want to have the procedure done.” Which of the following are appropriate nursing responses?

Accepted Answer

Answer reason: A competent client may revoke consent at any time, including immediately before the procedure, and the nurse must advocate for the client’s autonomous decision. The nurse’s priority action is to communicate the withdrawal to the provider who is performing the procedure so the plan can be stopped and the provider can address questions and document the refusal. Telling the client the form is “legally binding” is inaccurate and coercive, undermining voluntary consent. The nurse should not independently cancel surgery, and continuing pre-op preparation after a clear refusal violates client rights and creates legal/ethical risk.

Question 20

The nurse has received the following information about clients who are scheduled for procedures. It would be essential to follow up if a client?

Accepted Answer

Answer reason: Moderate Alzheimer’s disease commonly impairs cognition and judgment, so a signature alone does not confirm the consent is legally and ethically valid. The nurse must follow up to verify capacity and, if the client lacks capacity, ensure consent is obtained from the legally authorized representative before proceeding. By contrast, anxiety pre-op is expected and addressed with teaching/support, a clear-liquid breakfast may still violate NPO depending on policy but is less legally critical than potentially invalid consent, and a pre-LP headache is not a contraindication by itself.

Question 21

While caring for a 24-year-old primigravid client scheduled for emergency surgery because of a probable ectopic pregnancy, the nurse should?

Accepted Answer

Answer reason: Informed consent requires that the provider has explained the procedure, risks, benefits, and alternatives and that the client is competent and voluntarily agrees. The nurse’s role is to verify the client’s identity, ensure the consent form is completed, and witness the signature, especially before an emergency operative intervention for suspected ectopic pregnancy. Ectopic rupture often causes concealed intraperitoneal hemorrhage rather than massive external bleeding, making that assessment less directly relevant than ensuring legal/ethical readiness for surgery. Promising that the tube can be salvaged is inappropriate because surgical findings determine whether salpingostomy vs salpingectomy is possible. Monitoring uterine contractions does not address the immediate preoperative priority for an emergent ectopic case.

Question 22

After receiving detailed information about a colonoscopy from the health care provider (HCP), the nurse asks the client to sign the informed consent form and discovers that the client cannot write. Which is the best intervention for the nurse to implement?

Accepted Answer

Answer reason: The core principle is that the provider is responsible for explaining the procedure and obtaining informed consent, while the nurse verifies the client’s identity, capacity, voluntariness, and that the consent is properly executed. If a client is unable to write but is competent and agrees, an “X” mark is an acceptable signature when witnessed to validate authenticity. Having two nurse witnesses strengthens legal verification that the mark was made by the client after appropriate disclosure and without coercion. A verbal consent alone is typically insufficient when written consent is required for an invasive procedure, and contacting the provider is unnecessary if the provider already provided the explanation and the issue is only the client’s inability to write.

Question 23

A 9-year-old child diagnosed with leukemia is scheduled for a bone marrow aspiration tomorrow. Regarding his informed consent, which initial nursing action is most appropriate?

Accepted Answer

Answer reason: Children generally cannot provide legal informed consent, but they should be involved in decision-making through assent when developmentally appropriate. A 9-year-old can usually understand a simple explanation of what will happen and express willingness, so obtaining assent is an appropriate initial nursing action to support autonomy and reduce anxiety. Parental permission is still required for the procedure, but engaging the child first helps ensure cooperation and ethical care. The nurse’s role includes facilitating understanding and verifying the process, while the provider is responsible for obtaining the informed consent.

Question 24

The nurse witnessed a signed informed consent for an inguinal hernia repair surgery. During the procedure, the surgeon discovers a secondary ventral hernia that also requires repair. Which action should the nurse perform?

Accepted Answer

Answer reason: A nurse cannot alter a signed consent, and an intraoperative finding that is not immediately life-threatening does not justify expanding the surgery without specific consent. The appropriate action is to ensure the finding is documented and that the client is informed postoperatively so an additional, properly consented procedure can be planned. Contacting a medical power of attorney is generally reserved for an incapacitated client and still does not solve the requirement that consent be obtained before the added procedure is performed.

Question 25

The nurse is witnessing a client provide informed consent. The client is demonstrating which ethical principle?

Accepted Answer

Answer reason: Informed consent is grounded in the ethical principle that competent clients have the right to make their own healthcare decisions after receiving adequate information. Signing consent indicates the person is exercising self-determination regarding acceptance or refusal of a proposed treatment. The nurse’s role as a witness supports that the decision is voluntary and that the client appears to understand what is being agreed to, which aligns with respect for the individual’s decision-making capacity. Justice refers to fairness in distribution of resources, paternalism is overriding the client’s preferences “for their own good,” and veracity is truth-telling, none of which are the primary principle represented by the act of informed consent.

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