# A 46-year-old client is scheduled for an elective laparoscopic cholecystectomy. At 0700 the client was alert and oriented, and the surgeon explained the procedure but left before answering the client's final question about complications; the consent form was not signed. At 0750 the client received prescribed midazolam 2 mg IV for anxiety. At 0805 the client is drowsy but arousable to voice, respiratory rate is 14/min, and oxygen saturation is 97%. The client asks, "Why am I having surgery?" and says, "I don't remember what the risks were." The client does not say that they want to cancel. Temperature is 36.8°C. The client's adult daughter is present, and transport staff ask the nurse to get the form signed so the operating room schedule is not delayed. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617422&lang=en > language: en > subject: Informed Consent > category: MOC ## Question A 46-year-old client is scheduled for an elective laparoscopic cholecystectomy. At 0700 the client was alert and oriented, and the surgeon explained the procedure but left before answering the client's final question about complications; the consent form was not signed. At 0750 the client received prescribed midazolam 2 mg IV for anxiety. At 0805 the client is drowsy but arousable to voice, respiratory rate is 14/min, and oxygen saturation is 97%. The client asks, "Why am I having surgery?" and says, "I don't remember what the risks were." The client does not say that they want to cancel. Temperature is 36.8°C. The client's adult daughter is present, and transport staff ask the nurse to get the form signed so the operating room schedule is not delayed. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. Condition Select 1 Refusal of the planned procedure Preoperative anxiety with intact capacity Temporary loss of capacity from sedation Acute delirium from an underlying illness Actions to take Select 2 Notify the surgeon that consent is not obtained Explain the risks and witness the client's signature Ask the adult daughter to sign the consent form Delay transfer until the client can take part Give prescribed flumazenil to reverse the sedation Parameters to monitor Select 2 Anxiety rating on a 0–10 scale Respiratory rate after flumazenil Sedation score on the RASS Temperature and white blood cell count Teach-back of the procedure's risks ## Explanation The client was capable before midazolam but is now drowsy and cannot recall the risks, so decision-making capacity is temporarily impaired by sedation. For an elective procedure, the nurse notifies the surgeon that consent has not been obtained and delays transfer until the client can take part. A surrogate signature is not appropriate while the client is expected to regain capacity, and explaining risks is the surgeon's role. ## In-depth explanation Quick answer Temporary loss of decision-making capacity from sedation. Notify the surgeon that consent has not been obtained and delay transfer until the client can take part. Monitor the RASS sedation score and the client's ability to restate the risks. Why this is correct Capacity means understanding, remembering, weighing, and communicating a decision. The client could do this at 0700 but, 15 minutes after IV midazolam, is drowsy and cannot recall the risks. That timing points to a temporary drug effect, not a psychiatric or infectious cause, and the client is not refusing. Because the procedure is elective, consent must wait until the client regains capacity and the surgeon answers the remaining question. The sedation score and teach-back of the risks show when capacity has returned. Easy analogy or mental picture A signature is a receipt, not the purchase. If the buyer was asleep during the sale, the receipt means nothing. Memory hook Sedated before signing? Stop, call the surgeon, and wait for the brain to come back. NCLEX decision rule For elective procedures, informed consent requires a client with capacity who received the information from the provider. A schedule delay never justifies an invalid signature. Why the other choices are wrong A surrogate such as the daughter signs only when the client lacks capacity and cannot regain it in time, which is not the case in an elective case with a short-acting sedative. Nurses witness signatures but do not provide procedure-specific risk explanations. Flumazenil is for dangerous benzodiazepine oversedation, and this client is arousable with a respiratory rate of 14/min; respiratory rate after flumazenil tracks that treatment, not capacity. Anxiety ratings fit anxiety with intact capacity, and temperature/WBC would track an infectious delirium, which the normal temperature and clear drug timing make unlikely. References 1CMS — Revisions to Hospital Interpretive Guidelines for Informed ConsentRequired elements of a properly executed informed consent 22026 NCLEX-RN Test Plan (NCSBN)Client rights and informed consent within Management of Care ## Clinical scenario Scenario A client given IV midazolam before signing consent is drowsy, cannot recall the risks, and still has an unanswered question; the procedure is elective, and staff are pressing for a signature. ## Key concepts - **Decision-making capacity** — The ability to understand, remember, weigh, and communicate a choice about a specific treatment. - **RASS** — Richmond Agitation-Sedation Scale, a numeric score from +4 (combative) to −5 (unarousable). - **Informed consent** — Voluntary agreement given after the provider explains the procedure, risks, benefits, and alternatives. ## Related questions - [A nurse is preparing a client for a scheduled abdominal surgery and reviewing requirements…](https://mymerci.kr/pages/nclex_q.php?qn_id=363984&lang=en) - [A client scheduled for colon resection has signed the consent form but says, "I still do n…](https://mymerci.kr/pages/nclex_q.php?qn_id=393660&lang=en) - [A client who speaks limited English is scheduled for surgery and has questions before sign…](https://mymerci.kr/pages/nclex_q.php?qn_id=394068&lang=en) - [Drag each action in an interpreted procedural-consent encounter to the team member with pr…](https://mymerci.kr/pages/nclex_q.php?qn_id=395495&lang=en) - [A client expresses uncertainty about surgery before receiving sedation. For each element, …](https://mymerci.kr/pages/nclex_q.php?qn_id=396207&lang=en) - [A client who speaks limited English is scheduled for a nonemergency procedure. The adult c…](https://mymerci.kr/pages/nclex_q.php?qn_id=396570&lang=en) - [A nurse gives a scheduled oral medication 2 hours late and the client has no adverse effec…](https://mymerci.kr/pages/nclex_q.php?qn_id=397132&lang=en) - [A client scheduled for surgery states, "I will not accept blood products for religious rea…](https://mymerci.kr/pages/nclex_q.php?qn_id=397240&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=617422&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=617422&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=617422&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=617422&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=617422&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._