A 35-year-old female client with cancer refuses to allow the nurse to insert an IV

• A. Call security to force access
• B. Administer IV against the patient's wishes
• C. Evaluate the client's mental status for competence to refuse treatment
• D. Ignore the patient's refusal since it's life-threatening

Answer: (C)

Respecting patient autonomy means the nurse must determine whether the patient has the capacity to refuse treatment. When a patient with cancer refuses IV therapy, the appropriate step is to evaluate decision-making capacity: can she understand the information about the IV, appreciate the consequences of refusing, reason about options, and communicate a clear choice? If she is competent, her decision must be honored, and the nurse should document the refusal, inform the physician, and ensure safety while offering alternatives and re-evaluation if her wishes change. If she lacks capacity due to confusion, delirium, pain, or cognitive impairment, a legally authorized representative should be involved and appropriate steps followed, possibly including an ethics consult. For completeness, forcing access or administering against consent would violate ethical and legal standards, and ignoring the refusal is inappropriate even in life-threatening situations.