A client with schizophrenia refuses antipsychotic medication despite showing signs of relapse. What should the nurse prioritize to ethically address this situation?
Educate the client about the benefits and risks involved
Discharge the client for noncompliance
Ignore the client's wishes if the family consents
Administer medication covertly to ensure compliance
The Correct Answer is A
Choice A reason: Prioritizing education respects the ethical principle of autonomy and the legal requirement for informed consent or refusal. By explaining the therapeutic benefits and potential side effects of antipsychotics, the nurse empowers the client to make a choice based on clinical facts, potentially improving therapeutic alliance and adherence.
Choice B reason: Discharging a client who is experiencing a symptomatic relapse of schizophrenia constitutes medical abandonment and is ethically unsound. The nurse has a duty of beneficence to ensure the client's safety and stabilization. Noncompliance is a symptom of the illness that requires clinical intervention rather than punitive discharge.
Choice C reason: Adult clients generally retain the right to refuse treatment unless they have been legally declared incompetent or meet criteria for involuntary emergency commitment. Family consent does not override a conscious client's refusal in most jurisdictions, and ignoring the client's wishes violates their fundamental right to self-determination and bodily integrity.
Choice D reason: Covert administration of medication, such as hiding crushed pills in food, is a violation of ethical standards and nursing practice acts. It destroys the trust essential to the nurse-client relationship and bypasses the informed consent process. Such actions are generally considered battery unless performed under specific, legally mandated emergency circumstances.
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Correct Answer is D
Explanation
Choice A reason: Fidelity refers to the nurse's obligation to be faithful to commitments and to keep promises made to the patient. It focuses on the individual nurse-patient relationship and the maintenance of trust through loyalty and veracity rather than the broader societal distribution of healthcare resources.
Choice B reason: Nonmaleficence is the ethical duty to "do no harm." In a psychiatric context, this involves protecting patients from injury, medication errors, or unnecessary restraints. While essential for bedside care, it does not directly address the systemic allocation of resources or social equity.
Choice C reason: Autonomy involves respecting the patient's right to make their own decisions regarding their treatment and healthcare. While advocacy can support autonomy by providing information, the specific act of seeking equal access for a whole population is a matter of distributive fairness.
Choice D reason: Justice is the ethical principle that focuses on fairness and the equitable distribution of benefits and burdens. When a nurse advocates for equal access to mental health resources regardless of socioeconomic status, race, or geography, they are promoting social and distributive justice within the healthcare system.
Correct Answer is C
Explanation
Choice A reason: While physical activity can sometimes help channel excess energy, it must be carefully controlled. In an acute manic state, high-energy activities can further increase physiological arousal and lead to physical exhaustion or cardiac strain. The priority is stabilization and calming the environment rather than promoting potentially agitating physical exertion.
Choice B reason: Group therapy is generally contraindicated during an acute manic episode. The client’s pressured speech, grandiosity, and impulsivity can be highly disruptive to other patients and may lead to social conflicts. The hyperactive nature of the client makes the structured, social demands of a group setting overwhelming and counterproductive.
Choice C reason: Decreasing environmental stimuli is the priority intervention because clients in a manic state are highly distractible and hyper-responsive to their surroundings. Minimizing noise, light, and social interaction helps lower the client's agitation level. One-to-one observation ensures immediate safety and allows the nurse to intervene before impulsive behaviors lead to injury.
Choice D reason: Although pharmacological intervention with antipsychotics or mood stabilizers is a necessary component of treatment, it is not the immediate nursing intervention for environmental safety. Chemical restraint or sedation should not be the first-line response when environmental modification and behavioral monitoring can effectively manage the client's immediate safety and agitation levels.
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