A community health nurse is performing a home visit for a client and is evaluating the home environment for safety. Which of the following findings would indicate to the nurse that the client has a proper understanding of safety in the home?

Choice A reason: Cheyne-Stokes respirations, alternating hyperventilation and apnea, indicate neurological dysfunction or end-of-life changes in brain tumor patients, not pain. This reflects brainstem involvement, requiring respiratory management rather than analgesics, as it is a physiological response to disease progression in palliative care.
Choice B reason: Mottled skin signals poor perfusion or impending death, common in palliative care as circulation declines. It is not a pain indicator but a sign of systemic shutdown, requiring comfort measures like warmth, not analgesics, which are irrelevant to this physiological change in terminal illness.
Choice C reason: Constricted pupils may reflect opioid effects or neurological changes in brain tumor patients but do not directly indicate pain. They suggest autonomic or brainstem dysfunction, necessitating neurological assessment, not immediate pain medication, in palliative care where comfort is prioritized based on clear pain cues.
Choice D reason: Grimacing indicates pain in palliative care patients with brain tumors, reflecting physical discomfort. As a facial expression of distress, it signals the need for analgesics to improve comfort and quality of life, aligning with palliative goals to manage pain effectively in end-stage disease.

Choice A reason: Beneficence, acting for patient benefit, is not breached, as both clients receive care and supplies, albeit differently. Unequal distribution reflects access issues, not failure to promote well-being, making beneficence less relevant than justice in addressing this ethical concern.
Choice B reason: Nonmaleficence, avoiding harm, is not violated, as both clients access supplies without direct harm. The inequality in delivery method raises fairness concerns, not harm, making justice the primary ethical principle breached in this scenario of differential treatment.
Choice C reason: Justice, ensuring fair treatment, is breached when one client receives supplies directly and another must seek them externally due to insurance status. This inequality in resource access violates equitable care principles, critical in healthcare ethics to ensure fairness across patient populations.
Choice D reason: Autonomy, respecting patient choices, is not breached, as both clients receive care consistent with their needs. The issue lies in unequal resource access, not decision-making restrictions, making justice the relevant ethical principle over autonomy in this scenario.