A nurse administers an incorrect medication to a client and does not complete an incident report because the client experienced no adverse effects. Which ethical principle did the nurse violate?

Choice A reason:
Asking the healthcare provider to speak with the client implies an attempt to change or challenge the client’s decision. The client has expressed acceptance of their prognosis and a clear preference for hospice care. In this situation, the issue is not lack of understanding or need for further medical clarification, but rather the nurse’s internal disagreement. Therefore, involving the provider is not the most appropriate initial action.

Choice B reason:
Collaborating with the team to convince the client to stay violates the ethical principle of autonomy. Clients with decision-making capacity have the right to refuse further treatment and choose hospice care. Attempting to persuade or pressure the client to continue treatment disregards their expressed wishes and may cause emotional distress.

Choice C reason:
When a nurse disagrees with a client’s end-of-life decision, the appropriate action is self-reflection. Examining one’s own values and beliefs about death and dying allows the nurse to provide nonjudgmental, client-centered care. This promotes professional boundaries, respects client autonomy, and ensures that personal beliefs do not interfere with ethical nursing practice.

Choice D reason:
Consulting the ethics committee is appropriate when there is an ethical conflict, uncertainty about decision-making capacity, or disagreement among parties regarding care. In this case, the client’s wishes are clear and ethically sound. The conflict exists within the nurse, not the care plan, making an ethics consultation unnecessary.

Choice A reason: Dextrose 2.5% with water is considered a hypotonic solution because it has a lower osmolarity than plasma. Administering hypotonic solutions moves water into the intracellular space, which can hydrate cells but does not pull fluid from the cells into the intravascular space.

Choice B reason: 0.9% sodium chloride, also called normal saline, is an isotonic solution because its osmolarity is approximately equal to that of plasma. It maintains fluid balance between the intravascular and interstitial spaces without causing significant fluid shifts into or out of cells.

Choice C reason: Dextrose 5% in water (D5W) is considered isotonic in the bag but becomes hypotonic after metabolism of dextrose. It provides free water that distributes throughout the intracellular and extracellular compartments, and it does not function as a hypertonic solution.

Choice D reason: 3% sodium chloride is a hypertonic solution because it has a higher osmolarity than plasma. Hypertonic solutions draw water out of cells into the intravascular space, which is useful in treating severe hyponatremia or cerebral edema. Administration requires careful monitoring to prevent fluid overload, hypernatremia, and cellular dehydration.