A charge nurse provides an annual in-service for the nursing staff regarding ethical practice. Which of the following actions should the nurse include as an example of ethical practice?
A nurse raises all four side rails on the bed of a client who is confused.
A nurse administers prescribed opioids to a client who has a terminal illness and respiratory rate of 8/min.
A nurse elects not to care for a client who had an abortion.
A nurse withholds nutrition from a client who has a do-not-resuscitate (DNR) order.
The Correct Answer is B
A. Raising all four side rails on a confused client’s bed is considered a restraint and violates the principle of autonomy. Restraints should only be used as a last resort and require a provider’s order. Ethical practice involves finding less restrictive alternatives, such as using a sitter or bed alarms.
B. Administering opioids to a terminally ill client, even with a low respiratory rate, aligns with ethical nursing principles such as beneficence (relieving suffering) and nonmaleficence (preventing harm) when used for palliative care. In end-of-life care, the priority is comfort, and pain management is considered ethical even if it may impact respiration. This aligns with the principle of double effect, which justifies an action intended for good (pain relief) even if it has potential negative side effects (respiratory depression).
C. Electing not to care for a client due to personal beliefs is an example of bias and does not adhere to the ethical principle of fidelity, which requires nurses to provide care regardless of personal beliefs.
D. Withholding nutrition from a client with a DNR order is not ethical unless there is a clear directive regarding the client's wishes, and it may cause harm.
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Correct Answer is B
Explanation
A. Total parenteral nutrition (TPN) tubing should generally be changed every 24 hours due to the risk of infection, so changing it every 48 hours would not be appropriate or safe.
B. Changing peripheral IV primary tubing every 96 hours is both safe and cost-effective. It aligns with evidence-based guidelines to reduce the risk of infection while avoiding unnecessary frequent changes.
C. Peripheral IV solution bags should be replaced more frequently than every 96 hours, typically every 24 hours, due to the risk of bacterial contamination.
D. TPN solution bags should be replaced every 24 hours, not every 48 hours, to prevent infection and maintain solution stability.
Correct Answer is D
Explanation
A. Notifying the provider is essential, but the immediate priority is to assess the client's current condition to determine if there are any adverse effects from the additional dose.
B. Completing an incident report is necessary for documentation and accountability but should follow the immediate assessment of the client's condition.
C. Informing the nursing supervisor is important for communication and oversight, yet the nurse must first observe the client to evaluate any immediate effects of the medication error.
D. Observing the client's condition is the first action because it helps to identify any potential complications or adverse reactions resulting from the additional dose of medication.
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