一位34歲男性因右腿嚴重創傷性骨折，即將進行緊急筋膜切開術。醫師已解釋過手術，但在接受靜脈注射 4 mg 嗎啡的5分鐘後，病患變得昏沉，並問護理師：「如果我不做這個手術，我的腿到底會怎樣？」護理師正拿著同意書。下列哪些處置是必須的？（選所有適合的）
A 34-year-old male with a severe traumatic right leg fracture is scheduled for an emergency fasciotomy. The provider explains the procedure, but five minutes after receiving IV morphine 4 mg, the patient becomes drowsy and asks the nurse, "What exactly happens to my leg if I don't do this?" The nurse is holding the consent form. Which actions are required? (Select all that apply.)
- AExplain the risks of not having the surgery directly to the patient.直接向病患說明不接受手術的風險。
- BNotify the provider that the patient requires further explanation of the procedure.✓ 正解通知醫師，該病患需要進一步說明手術程序。
- CHave the patient sign the consent form immediately before the morphine completely sedates him.在嗎啡完全鎮靜病患之前，讓病患立即簽署同意書。
- DIdentify a legally authorized representative to provide consent since the patient is medicated.✓ 正解鑑於病患已服藥，確認法定代理人以提供同意。
- EDocument the patient's exact question and the delay in obtaining the signature.✓ 正解記錄病患的確切問題及取得簽名的延遲情況。
本題核心是知情同意書（Informed Consent）的法律與倫理原則。根據 NCSBN 規範，護理師的責任是「見證病患自願簽署」並確認病患「已完全理解」。當病患詢問「不做手術會怎樣」時，代表其未獲充分知情，且解釋醫療風險是開刀醫師的法定責任，護士不得越權代為解釋（故排除A）。此外，病患剛注射了 4 mg 靜脈嗎啡並出現昏沉狀態，在藥物影響下已失去合法簽署同意書的行為能力（Competence），此時強行簽署將無效且違法（故排除C）。正確做法是：通知醫師回來重新解釋（選項B）；因為病患已被藥物影響，必須尋求其法定代理人或授權家屬來代為簽署（選項D）；並在護理紀錄中忠實記載病患的提問及同意程序延遲的客觀事實（選項E）。
Informed consent requires that the client fully understands the procedure and its risks, which is the legal responsibility of the provider performing the surgery. Since the client expressed confusion and was sedated by morphine, they lacked the capacity to consent, and the nurse must notify the provider to clarify the information. Additionally, because the client was impaired, a legally authorized representative should provide consent, and the nurse must document the client's questions and the delay objectively.
美國法規對使用鴉片類藥物後的行為能力剝奪有嚴格定義，必須立刻轉換為醫療授權委託人（MPOA）簽名；台灣雖有類似規範，但在急診「搶救生命」的灰色地帶時，若家屬未到場，有時可由兩位醫師啟動醫療緊急程序（免簽約條款），而不純粹依賴代理人。