A 35-year-old female client with cancer refuses to allow the nurse to insert an IV. What is the nurse's appropriate initial action?

• A. Evaluate the client's mental status for competence to refuse treatment
• B. Respect the decision without assessment
• C. Obtain a physician order for forced IV
• D. Ignore the patient's wishes

Answer: (A)

Evaluating decision-making capacity is the key idea here. When an adult patient with cancer refuses IV access, the nurse must first determine whether she has the ability to make that specific treatment decision. Capacity means she understands the information about the IV, appreciates the consequences of accepting or declining, can reason about options, and can communicate a clear, consistent choice. If she is found competent, her autonomous refusal should be respected after ensuring she has been fully informed and given a chance to ask questions. If she isn’t competent, then appropriate steps follow—often involving the physician to consider alternatives or protective measures—but that assessment and process come after checking capacity. The other options aren’t appropriate because refusing care without assessing capacity violates autonomy, forcing an IV without a competent basis isn't justified, and ignoring the patient’s wishes is unethical.