# A nurse is preparing a client for a scheduled abdominal surgery and reviewing requirements for informed consent. Which actions are appropriate for the nurse to perform? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=363984&lang=en  
> language: en  
> subject: Informed Consent  
> category: MOC

## Question

A nurse is preparing a client for a scheduled abdominal surgery and reviewing requirements for informed consent. Which actions are appropriate for the nurse to perform? Select all that apply.

1

Witness the client signature on the consent form

2

Verify that the client can describe the procedure in their own words

3

Ensure the consent is obtained before any pre-procedure sedation is administered

4

Provide detailed surgical risk information not previously covered by the surgeon

5

Sign the consent form on behalf of a competent adult client who is anxious about signing

## Explanation

The nurse role in informed consent is to witness the signature, verify client understanding, and ensure timing (before sedation). Providing the actual risks, benefits, and alternatives is the surgeon (provider) responsibility because they are performing the procedure. The nurse cannot sign on behalf of a competent adult; if the client refuses or cannot understand, the surgery should not proceed and the surgeon must be notified.

## In-depth explanation

Clinical Judgment
Three nurse responsibilities for informed consent: witness signature, verify understanding, secure timing. Three provider responsibilities: disclose risks/benefits/alternatives, answer technical questions, document discussion. Sedation invalidates consent capacity — always sign first.

Memory Tip
Nurse: Witness + Verify + Time. Provider: Disclose + Answer.

KR vs US
Joint Commission, AHA Patient Bill of Rights (US) and Korean Medical Service Act article 24-2 align: provider is responsible for disclosure; nurse witnesses and validates capacity. Both jurisdictions invalidate consent obtained after sedation.

## Clinical scenario

Clinical Practice Guide
Three pillars of valid informed consent:
- Capacity: client understands the information and consequences
- Disclosure: provider has explained risks, benefits, alternatives, and option of no treatment
- Voluntariness: free of coercion or sedation

Nurse documents:
- Time of signature relative to sedation (consent before sedation)
- Client understanding in own words
- Witness signature
- Any refusal or questions referred back to provider

Caution
Implied consent applies only in life-threatening emergency when the client cannot give consent and no surrogate is available. Routine surgery never qualifies for implied consent. A minor cannot consent except for emancipated minor situations or specific exceptions (STI, contraception in many states).

## Key concepts

- **Informed consent** — Voluntary agreement by a competent client to undergo a procedure after full disclosure of nature, risks, benefits, and alternatives. Components: capacity, disclosure (by provider), voluntariness, signature (witnessed by nurse).
- **Provider role vs nurse role** — Provider (physician, surgeon, NP, PA): discloses risks, benefits, alternatives, and answers technical questions. Nurse: witnesses signature, verifies understanding in client own words, ensures timing before sedation, documents.
- **Implied consent** — Consent presumed when a client cannot communicate (unconscious, incapacitated) and an emergency intervention is required to prevent death or serious harm. Limited to true emergency situations; never applies to routine planned surgery.

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