A nurse is caring for a client who has a terminal illness and wishes to discuss hospice care. Which of the following statements by the nurse demonstrates veracity?

A) Sublingual medication is crushed and administered through a client's gastrostomy tube: This scenario represents a violation of the client's right to refuse treatment or medication. Administering medication through a route other than the one prescribed without the client's consent is inappropriate and can result in harm or adverse effects.

B) Finger nail marks appear on a client's wrist after a radial pulse was taken: This scenario indicates a violation of the client's right to be free from abuse. Evidence of physical harm, such as finger nail marks, suggests that the client may have been handled roughly or experienced unnecessary force during the procedure, which is unacceptable.

C) Pain medication is administered 1 hr before a client has a dressing change: While administering pain medication slightly ahead of a painful procedure may be appropriate to provide optimal pain relief, it does not inherently violate the client's rights if it aligns with the client's pain management plan and preferences. Therefore, this scenario does not represent a clear violation of client rights.

D) The same indwelling urinary catheter is reinserted after a failed attempt: Reinserting the same urinary catheter after a failed attempt could represent a violation of the client's right to safe care and freedom from unnecessary discomfort. Repeated attempts at catheter insertion without clinical justification increase the risk of infection and discomfort for the client.

E) Medications scheduled four times a day are administered 2 hr after the scheduled time: Administering medications significantly late violates the client's right to receive care in a timely manner. Delayed medication administration can affect treatment efficacy and compromise the client's well-being, especially for medications with strict dosing schedules.

A) Send the client for the test with the unsigned form:

This option is not appropriate because performing an invasive procedure without obtaining informed consent from the client violates ethical and legal principles. Proceeding without proper consent could lead to legal and ethical repercussions, and it is not considered a safe or acceptable practice.

B) Wake the client and ask them to sign the form:

Waking the client who has received a sedative to obtain their signature on the consent form is not advisable. The client may still be under the influence of the sedative, which could impair their ability to understand the information provided and make an informed decision. Additionally, obtaining consent in this manner may not be legally valid and could compromise the client's autonomy and rights.

C) Obtain consent from a family member:

While obtaining consent from a family member might seem like a reasonable option, it is not appropriate in this scenario without clear documentation of the client's inability to provide consent. Consent for medical procedures should ideally be obtained directly from the competent adult client unless they are incapacitated or unable to make decisions. In this case, the client is asleep due to the sedative, but there is no indication that they are incapable of providing consent. Therefore, relying on a family member's consent without attempting to obtain it from the client first may not be ethically or legally justified.

D) Inform the charge nurse:

This is the most appropriate action to take initially. Informing the charge nurse allows for consultation and guidance on how to proceed in this situation. The charge nurse may advise on the appropriate steps to follow, such as contacting the provider or waiting for the client to regain consciousness to obtain informed consent. It ensures that the situation is addressed promptly and in accordance with institutional policies and ethical standards.