A nurse is caring for a client who has bipolar disorder and is refusing to take prescribed medications. Which of the following ethical principles is the nurse displaying when supporting the client's refusal of medications?

Choice A Reason: The belief that a partner will not be violent in the future can be a form of denial or wishful thinking, especially without any evidence of change or intervention. It is not uncommon for individuals in abusive relationships to hope for change, but without concrete actions, such as therapy or other interventions, this hope does not indicate an improvement in the client’s situation.

Choice B Reason: Agreeing to an appointment with a social worker is a positive step towards addressing the situation and seeking help. Social workers can provide support, resources, and guidance, which can be crucial for someone experiencing partner violence. This choice indicates a potential improvement in the client’s psychological status as it shows a willingness to engage with support services.

Choice C Reason: A decrease in reported pain levels can indicate physical improvement. Pain scales are subjective but provide a measure of the client’s comfort and can reflect healing or the effectiveness of pain management strategies.

Choice D Reason: Requesting help to develop a safety plan is a proactive step in ensuring personal safety and preparing for potential future incidents of violence. It shows the client’s awareness of the risks and a desire to protect themselves, which is a positive indicator of psychological improvement.

Choice E Reason: While claiming responsibility for the physical altercation may seem negative, it can also be seen as the client’s attempt to make sense of the situation. It is important to note that responsibility for violence lies with the perpetrator, not the victim. However, recognizing the dynamics of the relationship and the events leading up to the violence can be part of the healing process and taking control of one’s life.

Potential Condition:

a) Schizophrenia

Choice A reason: Schizophrenia is a chronic mental health condition characterized by symptoms such as delusions, hallucinations, disorganized speech, and significant social or occupational dysfunction. The client’s symptoms, including mumbling as if talking to unseen others and the belief that someone is trying to poison them, are indicative of psychotic features commonly associated with schizophrenia. The prescribed medications, clozapine and risperidone, are antipsychotics often used in the treatment of schizophrenia, further supporting this diagnosis.

Actions to Take:

d) Place the client in a room near the nurses’ station This action allows for close observation and quick intervention if the client’s condition worsens or if they exhibit behaviors that could be harmful to themselves or others.

f) Maintain the client taking their prescribed medications Continuing the prescribed antipsychotic medications is crucial for managing the symptoms of schizophrenia and preventing exacerbation of the condition.

Parameters to Monitor:

j) Command hallucinations Monitoring for command hallucinations is important as they can lead to dangerous behaviors, including harm to self or others, if the client acts on these hallucinations.

l) Suicidal ideation Patients with schizophrenia are at an increased risk for suicide, especially during acute episodes or when experiencing command hallucinations. Regular assessment for suicidal ideation is a critical component of care.