A nurse caring for an older client in the hospital is concerned ...

[madam-professor]

A nurse caring for an older client in the hospital is concerned the client is not competent to give consent for upcoming surgery. What action by the nurse is best?
 
  a. Call Adult Protective Services.
  b. Discuss concerns with the health care team.
  c. Do not allow the client to sign the consent.
  d. Have the client's family sign the consent.

Question 2

A nurse admits an older client from a home environment where she lives with her adult son and daughter-in-law. The client has urine burns on her skin, no dentures, and several pressure ulcers. What action by the nurse is most appropriate?
 
  a. Ask the family how these problems occurred.
  b. Call the police department and file a report.
  c. Notify Adult Protective Services.
  d. Report the findings as per agency policy.

[TINA]

Answer to Question 1

ANS: B
In this situation, each facility will have a policy designed for assessing competence. The nurse should bring these concerns to an interdisciplinary care team meeting. There may be physiologic reasons for the client to be temporarily too confused or incompetent to give consent. If an acute condition is ruled out, the staff should follow the legal procedure and policies in their facility and state for determining competence. The key is to bring the concerns forward. Calling Adult Protective Services is not appropriate at this time. Signing the consent should wait until competence is determined unless it is an emergency, in which case the next of kin can sign if there are grave doubts as to the client's ability to provide consent.

Answer to Question 2

ANS: D
These findings are suspicious for abuse. Health care providers are mandatory reporters for suspected abuse. The nurse should notify social work, case management, or whomever is designated in policies. That person can then assess the situation further. If the police need to be notified, that is the person who will notify them. Adult Protective Services is notified in the community setting.