What must be done if a patient is not oriented during the refusal process?

• A. Ignore orientation and proceed
• B. Document and discharge
• C. Call the primary physician's office
• D. Transport the patient or involve a surrogate

Answer: (D)

Not being oriented means the patient lacks the capacity to make an informed decision. Informed refusal requires understanding the risks, benefits, and consequences of declining care. If orientation is impaired, you can’t rely on their decision as truly informed, so the safest and most appropriate action is to transport the patient for evaluation or involve a surrogate who can provide consent on their behalf. This protects the patient’s safety and meets ethical and legal standards. Ignoring orientation would put the patient at risk, and discharging or attempting to rely on the physician later doesn’t address the immediate need for a valid decision.