# A 45-year-old male is alert and oriented ×4 and is actively bleeding from a gastrointestinal source with a hemoglobin of 7.1 g/dL. The surgeon recommends an urgent blood transfusion. The client calmly states he is a Jehovah's Witness and refuses the transfusion. Which action should the nurse take?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372683&lang=en  
> language: en  
> subject: Client Rights  
> category: MOC

## Question

A 45-year-old male is alert and oriented ×4 and is actively bleeding from a gastrointestinal source with a hemoglobin of 7.1 g/dL. The surgeon recommends an urgent blood transfusion. The client calmly states he is a Jehovah's Witness and refuses the transfusion. Which action should the nurse take?

## Option

1. Contact the hospital ethics committee to request an override of the client's refusal.
2. Sedate the client and administer the transfusion per the physician's recommendation.
3. Document the informed refusal and continue to monitor the client with supportive care. **✔ Correct answer**
4. Administer the blood transfusion because it is a life-saving intervention.

**Correct answer: 3**

## Explanation

A competent, alert adult has the legal and ethical right to refuse any treatment, including life-saving interventions, based on personal or religious beliefs. The nurse must ensure the client understands the consequences of refusal, document informed refusal thoroughly, notify the provider, and continue supportive care. Administering treatment against a competent adult's informed refusal constitutes battery. Ethics committees support decision-making but cannot override a competent patient's autonomous refusal.

## In-depth explanation

Clinical Judgment
Alert × 4 = legally competent. Competent adults may refuse any intervention, even life-saving ones. The nurse's role: ensure informed refusal is documented; advocate for client autonomy; continue supportive care. Do NOT override or circumvent.

Memory Tip
Competent + Informed + Refuses = DOCUMENT and RESPECT. Capacity ≠ Agreement.

KR vs US
In Korea, family often influences medical decisions. NCLEX upholds the individual client's right to refuse treatment regardless of family or physician preference.

## Clinical scenario

Clinical Practice Guide
ANA Code of Ethics (Provision 1): the nurse practices with compassion and respect for the inherent dignity and rights of every person. NCLEX: the right to refuse treatment is foundational — alert × 4 is always sufficient for decision-making capacity unless a formal capacity evaluation rules otherwise.

Caution
NCLEX will test this with high-stakes scenarios (massive bleed, low Hgb). The distractor is always "life-saving intervention overrides refusal." It does not.

## Key concepts

- **Autonomy** — The right of a competent adult to make decisions about their own medical care. Consent capacity = able to understand information, evaluate consequences, and communicate a decision. NCLEX: alert × 4 is sufficient evidence of capacity.
- **Informed Refusal** — The right of a competent patient to refuse treatment. The nurse must explain risks, confirm understanding, document the refusal, notify the team, and provide supportive care.
- **Battery (legal)** — Physical contact with a competent patient without consent. Even with good intent, administering a blood transfusion without consent constitutes battery. NCLEX: this is both an ethical violation and a criminal offense.

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