# A nurse is preparing an adult client for an open cholecystectomy and is reviewing the informed consent process. Which actions are within the registered nurse's responsibility for informed consent? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=365729&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question A nurse is preparing an adult client for an open cholecystectomy and is reviewing the informed consent process. Which actions are within the registered nurse's responsibility for informed consent? Select all that apply. 1 Assess the client's orientation and ability to understand and weigh information, and report concerns about decision-making capacity 2 Confirm that the consent is voluntary and that no coercion has occurred from family members or staff 3 Witness the client's signature on the consent form after confirming the client's identity using two identifiers 4 Verify that the client can describe the planned procedure in their own words and notify the surgeon if understanding is incomplete 5 Provide the detailed surgical risks, benefits, and alternatives because the client missed the surgeon's explanation earlier 6 Sign the consent form on behalf of the client when the client is anxious about signing personally ## Explanation The RN assesses orientation and the client's ability to understand and weigh information and reports concerns about decision-making capacity (Choice 1), confirms that consent is voluntary (Choice 2), witnesses the client's signature after verifying identity according to policy (Choice 3), and uses teach-back to verify understanding, stopping the process and notifying the surgeon if understanding is incomplete (Choice 4). The surgeon or other qualified procedural provider is responsible for explaining the detailed risks, benefits, and alternatives; the nurse should not substitute for that discussion (Choice 5). The nurse must not sign on behalf of a competent client (Choice 6). State law and facility policy govern the exact consent and witness process. ## In-depth explanation Informed Consent — Who Does What Surgeon/Provider: explains diagnosis, procedure, risks, benefits, alternatives, consequences of refusal. RN role: witness signature, verify identity, confirm understanding, assess capacity, ensure voluntariness. Capacity Criteria (4 elements) 1. Communicate a choice 2. Understand the information 3. Appreciate consequences 4. Reason through the decision Memory Tip "VICA-V": Voluntary, Identity, Capacity, Acknowledged understanding, Vitness signature. Caution If client received pre-op opioids/benzodiazepines, capacity may be impaired — STOP and notify surgeon. Telephone consent allowed only with two RN witnesses listening on the line. ## Clinical scenario Scenario Adult client, scheduled open cholecystectomy. Surgeon spoke with client 30 min ago. Client now states "I am not sure what they are going to do — something with my gallbladder?" Nurse Action Path 1. Do NOT have client sign yet 2. Document specific gaps in understanding 3. Notify surgeon to return for additional discussion 4. After surgeon clarifies, reassess understanding 5. Witness signature when client can describe procedure in own words Red Flags Requiring Stop - Pre-op sedation given - Capacity concern (dementia, intoxication, severe pain) - Family pressuring client - Language barrier without certified interpreter ## Key concepts - **Informed consent (legal elements)** — Required elements: disclosure of nature, purpose, risks, benefits, alternatives; client capacity; voluntariness; understanding. The provider performing the procedure has the legal duty to disclose; the RN witnesses signature and verifies the elements are met. - **Decision-making capacity** — Clinical, not legal, determination. Four abilities: communicate a choice, understand information, appreciate consequences, reason through options. Capacity can fluctuate (delirium, sedation) and is decision-specific. - **RN role in consent** — Witness signature, verify two identifiers, confirm client's understanding in their own words, assess capacity, ensure voluntariness, document any gaps and notify provider. RN may NOT obtain consent or explain medical/surgical specifics. ## Related questions - [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. 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