A client is scheduled to undergo a bone marrow biopsy. What is the priority nursing responsibility before the procedure begins?
A 30-year-old client with suspected leukemia is scheduled for a bone marrow biopsy from the posterior iliac crest. The client appears anxious and asks multiple questions about the procedure.
1Administer prescribed analgesic medication 30 minutes before the procedure
2Obtain informed consent and verify the client understands the procedure✓ 정답
3Position the client in prone position on the examination table
4Prepare the biopsy site with antiseptic solution using sterile technique
해설
Obtaining informed consent and verifying client understanding is the priority before any invasive procedure, as it upholds legal and ethical standards. Other interventions (analgesia, positioning, site prep) are important but secondary to consent.
Understanding the Priority: Safety and Legal Foundations
Before any invasive procedure such as a bone marrow biopsy, the nurse's priority responsibility centers on client safety and legal/ethical practice. While positioning, site preparation, and pre-medication are important nursing actions, they are all dependent upon a single, critical precursor: ensuring the client has given informed consent and verifying their understanding. This is not merely a form to be signed; it is a process that protects the client's autonomy and the legal integrity of the healthcare team. The correct sequence of events in procedural preparation is foundational to NCLEX-RN practice, and this question tests your ability to distinguish a dependent or interdependent action from the independent, legally mandated nursing responsibility that must occur first.
Analysis of the Options
* Option 1: Administer prescribed analgesic medication 30 minutes before the procedure.
This is a dependent nursing action requiring a valid prescription. Administering a central nervous system depressant like an analgesic or sedative before confirming the client understands and agrees to the procedure is a serious error. The medication could alter the client's mental status, rendering them legally incapable of providing valid consent. The procedure must not proceed if consent is obtained after the client's cognition is impaired.
* Option 2: Obtain informed consent and verify the client understands the procedure.
This is the correct priority. The nurse's independent responsibility is to act as a client advocate. The healthcare provider performing the biopsy is responsible for explaining the procedure, risks, benefits, and alternatives. The nurse's role is to witness the client's signature and, more importantly, to verify that the client's questions have been answered and that they demonstrate comprehension. If the client appears anxious and has multiple questions, as in this scenario, the nurse must halt the process, notify the provider, and ensure a satisfactory explanation is given before any other preparatory steps are taken. This aligns with the ethical principle of autonomy and legal standards for battery.
* Option 3: Position the client in prone position on the examination table.
Positioning the client in a prone position is the correct physical preparation for a posterior iliac crest biopsy. However, this is a comfort and access measure that logically follows after the client has been fully informed and has agreed to the procedure. Positioning a client who still has unresolved questions and has not formally consented would be a violation of their rights.
* Option 4: Prepare the biopsy site with antiseptic solution using sterile technique.
This is a critical infection control measure performed just before the procedure begins. However, initiating any physical preparation, including sterile site preparation, before obtaining valid informed consent is a breach of protocol. It presumes consent that has not yet been legally confirmed and can increase client anxiety by making them feel the procedure is imminent before they are ready.
Connecting to Procedural Sedation Nursing Practice
The criticality of verifying understanding before proceeding is reinforced by evidence from pediatric procedural sedation nursing. A retrospective descriptive study analyzing procedural sedation in a pediatric ward found that sedation was administered by specialized nurses for various procedures . The study's focus on identifying adverse events and sedation failure implicitly relies on a rigorous pre-procedural safety checklist, of which verified consent is the cornerstone. The study highlights that a structured nursing practice is essential for safe outcomes. The nurse's role in ensuring the consent is valid is a universal safety standard, applicable to all patients undergoing invasive procedures, from a bone marrow biopsy in an anxious adult to sedation for a pediatric scan. Without this foundational step, all subsequent nursing actions, no matter how skillfully performed, are built on an unsafe and unethical premise .
Clinical Scenario
A 30-year-old client with suspected leukemia is scheduled for a bone marrow biopsy from the posterior iliac crest. The client is anxious and asking multiple questions. Before any other preparation, the nurse must ensure the informed consent form is signed and that the client can verbalize understanding of the procedure, its purpose, risks, and benefits.
Nursing Priorities & Legal Safeguards
Verify Consent First: Confirm the provider has explained the procedure and the client's signature is on the form. Assess for questions and notify the provider if understanding is not demonstrated.
Never Pre-medicate Before Consent: Do not administer sedatives or opioid analgesics until consent is verified, as these can alter cognition and invalidate the legal agreement.
Act as Client Advocate: The nurse's role is to witness the signature and ensure the decision is voluntary. If the client appears coerced or confused, the procedure must be paused.
Step-by-Step Procedural Sequence
Validate informed consent and answer remaining questions.
Perform hand hygiene and apply standard precautions.
Position the client prone with a pillow under the hips to elevate the iliac crest.
Prepare the site with an antiseptic solution (e.g., chlorhexidine) using sterile technique.
Administer prescribed analgesic or anxiolytic if ordered and consent remains valid.
Assist the provider during the biopsy and monitor for vasovagal response or bleeding.
Post-Procedure Monitoring
Apply firm pressure to the site for 5-10 minutes, apply a sterile pressure dressing, and instruct the client to lie on the site for 30-60 minutes. Monitor vital signs and assess for signs of hemorrhage, infection, or hematoma formation. Educate the client to keep the dressing dry and in place for 24 hours.
Informed Consent — A legal and ethical process requiring the healthcare provider to explain a procedure, including risks and benefits, and the client to demonstrate understanding and voluntary agreement before the procedure is performed.
Bone Marrow Biopsy — An invasive diagnostic procedure in which a needle is inserted into the bone, typically the posterior iliac crest, to obtain a core of bone marrow tissue for examination.
Nursing Priority — The most critical nursing action based on client safety, legal mandates, and ethical principles, often determined using frameworks like Maslow's hierarchy or the nursing process.
Client Autonomy — The ethical principle recognizing the client's right to make informed decisions about their own medical care without coercion.