hard · NCLEX-RN Management of Care
Client: Robert, age 58. Setting: Cardiac Telemetry Unit. History: Post-myocardial infarction; scheduled for a coronary angiogram in 2 hours. Active Event: The client suddenly states, 'I changed my mind. I am not having this procedure, and I want to go home.' Vital Signs: BP 132/78 mm Hg, HR 82/min, RR 16/min, SpO2 97% on room air.
The client is exercising his right to refuse a scheduled cardiac catheterization. Place the following nursing actions in the correct chronological order to safely manage this informed refusal and protect the client's rights.
- Assess the client's understanding of the risks of refusal and confirm their decision-making capacity.
- Notify the primary healthcare provider and the interprofessional team of the client's refusal.
- Witness the client's signature on the official against medical advice or informed refusal form.
- Document the client's stated reasons, the specific risks explained, and the completed refusal paperwork in the health record.
- Update the nursing care plan to provide alternative comfort-based therapies and ensure no abandonment of care.
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