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 he supports the client's refusal of medications?

Choice A rationale:

Alcohol toxicity typically presents with symptoms such as confusion, slurred speech, and ataxia, rather than paranoia ("People are out to get me"). While alcohol can cause increased heart rate and blood pressure, it is not the most likely substance to cause these symptoms in the context of paranoia.

Choice B rationale:

Heroin toxicity is characterized by central nervous system depression, pinpoint pupils, and respiratory depression, which do not align with the client's symptoms of paranoia, tachycardia, and hypertension.

Choice C rationale:

Opium toxicity shares some similarities with heroin toxicity, including central nervous system depression and pinpoint pupils. It is not typically associated with paranoia or the vital sign changes described in the scenario.

Choice D rationale:

Cocaine toxicity is the most likely cause of the client's symptoms. Cocaine can lead to paranoia, tachycardia, and hypertension. The combination of these symptoms suggests acute cocaine toxicity, making it the priority concern for the nurse. Prompt intervention is necessary to address the potential life-threatening effects of cocaine toxicity.

Answer is: **Stop the newly licensed nurse from administering the medication.**

Explanation:the first step in dealing with a client who is manic and refuses treatment is to stop the nurse from administering the medication. This is because giving an injection to a patient in an agitated and manic state could be dangerous for both the patient and the nurse¹². The nurse manager should follow the principle of least restrictive intervention when handling such a situation².

The other options are incorrect because:

- Assessing the need for physical restraints is not a priority action, as it may escalate the situation and cause more harm than good¹².
- Demonstrating how to verbally de-escalate the situation is also not a priority action, as it may not be effective if the client is too agitated or irrational to listen¹².
- Discussing the purpose of the medication with the client may be helpful, but it should be done after assessing the need for physical restraints and trying other methods of communication¹².