# Situation: A 60-year-old man is admitted the day before an elective open abdominal operation under general anesthesia. He has type 2 diabetes mellitus and hypertension. He has no history of delayed gastric emptying, no gastrointestinal symptoms, and no known drug allergies. The surgeon explained the operation, and the client signed the consent form an hour ago. As the nurse reviews the form with him, he says, "I signed it, but I still do not know if they will remove part of my intestine or only take a sample." What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629666  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 60-year-old man is admitted the day before an elective open abdominal operation under general anesthesia. He has type 2 diabetes mellitus and hypertension. He has no history of delayed gastric emptying, no gastrointestinal symptoms, and no known drug allergies.

The surgeon explained the operation, and the client signed the consent form an hour ago. As the nurse reviews the form with him, he says, "I signed it, but I still do not know if they will remove part of my intestine or only take a sample." What should the nurse do?

## 보기

1. Describe the planned operation to him using the chart
2. Proceed, because his signature already makes it valid
3. Notify the surgeon so his questions are answered first **✔ 정답**
4. Ask his wife to go over the plan with him at the bedside

**정답: 3**

## 해설

The surgeon, as the person performing the procedure, obtains informed consent; the nurse confirms that the client understands and witnesses the signature. A client who does not understand what will be done has not given valid informed consent, so the nurse notifies the surgeon before surgery and before any preoperative sedation.

## 심화 해설

Core issue The client signed the consent form, but his statement reveals he does not understand the planned procedure. This means the ethical and legal requirements for informed consent have not been met.

Why the signature alone is not enough Informed consent is not simply a signature on a document. It is a process that requires three fundamental elements: the patient must be competent, adequately informed, and free from coercion [1][2]. When the client says he does not know whether part of his intestine will be removed or only a sample will be taken, he is demonstrating that the “adequately informed” criterion is absent. A signature obtained without genuine understanding does not constitute valid informed consent.

Role of the nurse versus the surgeon The person performing the procedure—the surgeon—holds the primary responsibility for obtaining informed consent. The nurse’s role is to confirm understanding and witness the signature, not to provide new procedural information that the surgeon has not already explained. In this situation, the client has a specific question about the surgical plan that only the surgeon can properly clarify. The nurse must notify the surgeon so the client’s questions are answered before surgery and before any preoperative sedation is given.

Why the other options are unsafe Describing the operation using the chart goes beyond the nurse’s witnessing role and risks giving incomplete or inaccurate information. Proceeding because the signature exists ignores the client’s clear lack of understanding. Asking the wife to explain the plan shifts responsibility away from the person who will perform the procedure and does not guarantee accurate information.

| Option | Problem |
| --- | --- |
| 1. Describe the operation using the chart | Nurse is not the proceduralist; risks providing incomplete or incorrect details |
| 2. Proceed based on signature | Signature without understanding is not valid informed consent |
| 3. Notify the surgeon | Correct—surgeon must address the client’s questions before surgery |
| 4. Ask the wife to explain | Does not ensure accurate information from the responsible provider |

Key point! A client who cannot state what procedure will be performed has not given valid informed consent, regardless of a signed form. Watch out! Preoperative sedation must not be given until the surgeon has clarified the plan and the client confirms understanding, because sedation can impair the client’s capacity to make an informed decision [2].

Informed consent is rooted in respect for patient autonomy and is incorporated into a process of shared decision making between the patient and the physician [2]. The nurse’s ethical duty is to protect that process by recognizing when understanding is incomplete and acting to correct it before the procedure proceeds [1].References (research sources)

- [1]Informed consent-It's more than a signature on a piece of paper.Research articleCocanour CS (2017) · DOI: 10.1016/j.amjsurg.2017.09.015

- [2]Informed consent.Research articleBernat JL (2001) · DOI: 10.1002/mus.1046

## 임상 시나리오

Informed Consent ValidationWhen a signed form does not mean understanding
Informed consent requires competence, adequate information, and freedom from coercion. A client who cannot state what procedure will be done has not met the information criterion, making the consent invalid.

The surgeon performing the procedure holds primary responsibility for explaining it and obtaining consent. The nurse's role is to confirm understanding and witness the signature, not to provide new surgical details.

CautionNotify the surgeon before surgery and before any preoperative sedation. Sedation can impair the client's ability to give valid consent, so clarification must occur while the client is still fully alert.

## 핵심 개념

- **Informed Consent** — A process requiring competence, adequate information, and freedom from coercion; a signature alone is insufficient.
- **Nurse's Role in Consent** — To confirm client understanding and witness the signature, not to provide new procedural information.
- **Surgeon's Responsibility** — The person performing the procedure holds primary responsibility for obtaining informed consent.

## 같은 주제 문제

- [Situation: A 60-year-old man is admitted the day before an elective open abdominal operati…](https://mymerci.kr/pages/nclex_q.php?qn_id=629667)
- [Situation: A 60-year-old man is admitted the day before an elective open abdominal operati…](https://mymerci.kr/pages/nclex_q.php?qn_id=629668)
- [Situation: A 60-year-old man is admitted the day before an elective open abdominal operati…](https://mymerci.kr/pages/nclex_q.php?qn_id=629669)
- [Situation: A 28-year-old man weighing 64 kg undergoes elective open repair of an inguinal …](https://mymerci.kr/pages/nclex_q.php?qn_id=629670)
- [Situation: A 28-year-old man weighing 64 kg undergoes elective open repair of an inguinal …](https://mymerci.kr/pages/nclex_q.php?qn_id=629671)
- [Situation: A 28-year-old man weighing 64 kg undergoes elective open repair of an inguinal …](https://mymerci.kr/pages/nclex_q.php?qn_id=629672)
- [Situation: A 55-year-old woman weighing 70 kg is recovering from an open abdominal operati…](https://mymerci.kr/pages/nclex_q.php?qn_id=629673)
- [Situation: A 55-year-old woman weighing 70 kg is recovering from an open abdominal operati…](https://mymerci.kr/pages/nclex_q.php?qn_id=629674)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._