NCLEX-RNManagement of CareMedium
An alert and oriented client with end-stage renal disease refuses a scheduled hemodialysis session, stating, 'I'm tired of this, I don't want treatment today.' The nurse has explained the risks of refusing. What is the nurse's next best action?
- AContact the client's healthcare proxy to override the decision
- BAdminister the treatment because refusal could be life-threatening
- CAsk a family member to convince the client to accept dialysis
- DDocument the refusal and the client's understanding of the risks, then notify the physician
Show answer & explanationAnswer & explanation
Correct answer: D. Document the refusal and the client's understanding of the risks, then notify the physician
A competent adult has the legal right to refuse treatment even if it may be life-threatening, after being informed of the risks. The nurse's role is to document the informed refusal and notify the physician, not to override the decision or coerce the client.
Why the other options are wrong
- A. A healthcare proxy has no authority when the client is competent and can speak for themselves.
- B. Forcing treatment on a competent, informed client violates their right to refuse.
- C. Coercing the client through family violates client autonomy and rights.
Client Right to Refuse Treatment
Competent adults have the legal right to refuse any medical treatment, even life-sustaining care, after being informed of the risks of refusal.
- Right to refuse is protected even for life-threatening conditions if client is competent
- Nurse must document informed refusal and notify provider
- Coercion or forcing treatment is battery and a violation of client rights
Memory trick: Competent = the client's choice is final