A client who is unconscious and has extensive internal injuries arrives via ambulance to the emergency department. The staff cannot reach the client's family. Which of the following permits the staff to proceed with emergency surgery?

Choice A Reason:
Telling the client that their blood alcohol level will be checked is incorrect. Threatening the client with other forms of testing may not be ethically or legally appropriate, especially if the client has refused the initial request. It's important to respect the client's autonomy and right to refuse testing.
Choice B Reason:
Informing the client that a catheter will be inserted is incorrect. Inserting a catheter against the client's will is invasive and would constitute a violation of the client's autonomy and bodily integrity. It is not an appropriate action.
Choice C Reason:
Documenting the client's refusal in their chart is correct. Documenting the client's refusal is essential for accurate record-keeping and ensures that the healthcare team is aware of the client's decision. It also helps protect the nurse and the healthcare facility in case of any legal or ethical challenges related to the client's refusal.
Choice D Reason:
Assessing the client for urinary retention is incorrect. While urinary retention may be a concern in some cases, it is not the immediate action to take when a client refuses to provide a urine sample. The priority is to respect the client's autonomy and document their refusal appropriately. If there are clinical indications or concerns about urinary retention, they can be assessed separately and addressed accordingly.

Choice A Reason:
Having the client sign a consent for treatment is not appropriate. In emergency situations where a patient's life or health is in immediate danger, obtaining written consent may not be feasible or appropriate. The priority is to provide necessary medical treatment and stabilize the patient's condition. Consent may be obtained verbally if possible, but it should not delay urgent interventions.
Choice B Reason:
Contacting the client's next of kin to obtain consent for treatment is not appropriate. While it's important to involve the patient's family or next of kin in decision-making when possible, obtaining consent from them in an emergency may not be practical or timely. The focus should be on providing immediate medical care to stabilize the patient.
Choice C Reason:
Notifying risk management before initiating treatment is not appropriate. Risk management concerns are important in healthcare settings, but in emergency situations where a patient's life is at risk, the priority is to provide urgent medical care. Risk management can be addressed after the patient has been stabilized.
Choice D Reason:
Proceeding with treatment without obtaining written consent is appropriate. In emergency situations, healthcare providers have a duty to provide care without delay to stabilize the patient's condition. Written consent may be obtained later if the patient becomes stable or when circumstances allow. The primary focus is on providing necessary medical interventions to address the disorientation and cardiac arrhythmia.