A nurse is caring for a group of clients in a medical-surgical unit. The nurse should ensure that the client has signed an informed consent form prior to which of the following procedures? (Select all that apply.)

A. "I do not want to have any surgery for my cancer." This indicates the client's decision to refuse treatment, and the nurse should advocate by respecting and supporting the client's autonomy.
B. "I have contacted another surgeon to get a second opinion." Seeking a second opinion demonstrates proactive decision-making and does not require advocacy.
C. "I will discuss treatment options next week after thinking about this." The client is demonstrating autonomy by requesting time to consider options.
D. "I will take chemotherapy since my family wants me to." This indicates external pressure rather than autonomous decision-making, necessitating the nurse's role as an advocate.

Client 1 (First Priority):

• Experiencing command hallucinations: Command hallucinations are auditory hallucinations that instruct the client to harm themselves or others, posing an immediate safety concern.
• Potential risk of self-harm: Persecutory delusions and statements indicating "the agents are watching" suggest escalating paranoia, increasing the risk of dangerous behaviors or impulsive self-protective actions. Immediate intervention is essential to prevent harm.

Client 2 (Lower Priority):

• Stopped taking medication: Non-compliance with medication has led to severe depressive symptoms, including isolation, withdrawal, and psychomotor retardation.
• Becoming isolated and withdrawn: While concerning, the risk is lower than active command hallucinations, making this a lower priority for immediate assessment. However, this client requires evaluation soon after Client 1.

Client 3 (Lowest Priority):

• Low lithium level (0.7 mEq/L): This level is slightly below the therapeutic range (0.8 to 1.2 mEq/L) but not critically dangerous.
• Increased risk of agitation and instability: The symptoms of agitation and poor sleep are concerning, but immediate safety threats are less imminent compared to command hallucinations.