A nurse is reinforcing teaching about delegation to assistive personnel (AP) with a newly licensed nurse. Which of the following statements should the nurse include in the teaching?

The correct answer is Choice C.

Choice A rationale: Obtaining consent directly from a client who has received IV morphine sulfate is invalid due to impaired cognitive function. Morphine acts on mu-opioid receptors in the central nervous system, reducing alertness, memory retention, and decision-making capacity. Informed consent requires full comprehension of risks, benefits, and alternatives. Morphine’s sedative effects compromise this standard. Normal Glasgow Coma Scale should be 15 for full alertness; sedation lowers this, rendering consent legally and ethically unsound.

Choice B rationale: The nurse cannot legally sign the consent on behalf of the client, even if the client is acknowledged. This violates the principle of autonomy and informed decision-making. The nurse’s role is to witness the client’s signature, not substitute it. Morphine impairs cognition, and any consent obtained under its influence is invalid. Legal standards require that the client be alert, oriented, and capable of understanding the procedure. Proxy consent must be pursued if capacity is compromised.

Choice C rationale: When a client is under the influence of opioids and lacks decision-making capacity, consent must be obtained from a legally authorized representative, such as a relative or healthcare proxy. Morphine alters consciousness and impairs executive function, making the client temporarily incompetent. Legal surrogates are empowered to make healthcare decisions in such cases. This ensures ethical compliance and protects patient rights. The nurse must verify documentation of proxy authority before proceeding with consent.

Choice D rationale: Delaying the procedure may be necessary if no authorized proxy is available, but it is not the first action. The priority is to identify and contact a legally authorized representative to obtain valid consent. Delays can compromise care, especially in urgent surgical cases. The nurse must act promptly to secure proxy consent, ensuring procedural integrity and patient safety. Only if no proxy is reachable should delay be considered, with documentation of rationale.

Discussing clients at the table in the cafeteria [b], disposing of written report sheets into the facility trash receptacle [c], and sharing a personal password with a coworker [e] are all actions that jeopardize client confidentiality. Client information should be kept private and secure at all times. Discussing clients in public places or disposing of client information in an unsecured manner can result in unauthorized access to confidential information. Sharing personal passwords can also compromise the security of client information.

The other options do not jeopardize client confidentiality. Removing client information from fax machines immediately [a] helps to prevent unauthorized access to confidential information. Giving verbal reports at change of shift in a designated conference room [d] is a standard practice that allows for the secure transfer of client information between healthcare providers.