A nurse is caring for a group of clients.
The nurse demonstrates adherence to the ethical principle of fidelity by doing which of the following?

Choice A rationale

Beneficence is an ethical principle that obligates healthcare providers to act in the best interest of their patients. This involves performing actions that promote good and prevent harm, often encompassing preventative care, health promotion, and the provision of treatments that improve a patient's well-being. It is a proactive stance aimed at positive outcomes.

Choice B rationale

Justice in healthcare refers to the fair and equitable distribution of resources and access to care. It ensures that all individuals receive treatment without discrimination based on socioeconomic status, race, or other factors. This principle often guides decisions about resource allocation and public health policies to ensure fairness for all.

Choice C rationale

Nonmaleficence is a foundational ethical principle stating that healthcare professionals must avoid causing harm to their patients. This includes both intentional harm and unintentional harm due to negligence or lack of skill. It emphasizes the duty to protect patients from foreseeable risks and ensures that interventions do not worsen their condition.

Choice D rationale

Fidelity is the ethical principle that emphasizes loyalty, trustworthiness, and faithfulness to commitments made to patients. This includes maintaining confidentiality, honoring promises, and being true to one's professional responsibilities. It builds trust in the patient-provider relationship, which is crucial for effective care.

The nurse should recognize that the child is most likely experiencing A. Spasmodic croup as evidenced by their A. Parent’s reports.

Rationale for correct answers:
Spasmodic croup typically presents in toddlers aged 1–3 years with sudden onset of a barking, seal-like cough, often at night, without fever or signs of systemic illness. This condition is usually triggered by allergens or minor viral infections and lacks daytime respiratory distress. The child’s physical exam shows no wheezing or abnormal lung sounds, and the temperature is within normal limits (37.3°C), suggesting a non-infectious etiology like spasmodic croup rather than viral or bacterial illness.
Parent’s reports of hoarse, barking nighttime cough, normal daytime behavior, and absence of fever or appetite change are hallmark subjective cues for spasmodic croup. Objective findings during the visit are normal, so clinical suspicion relies heavily on the history provided.

Rationale for incorrect Response 1 Options:
Respiratory syncytial virus (RSV) typically presents with cough, nasal congestion, wheezing, and often respiratory distress or fever, none of which are present.
Epiglottitis presents with sudden onset of high fever, drooling, muffled voice, and severe respiratory distress, often requiring emergency airway management—not consistent with this child’s stable, playful presentation.
Acute laryngitis in toddlers is rare and typically presents with hoarseness but not the classic barking cough, and it usually follows viral upper respiratory symptoms.

Rationale for incorrect Response 2 Options:
Lung sounds are clear, so they don't support a diagnosis involving significant airway inflammation or obstruction.
Immunization history helps with disease prevention but doesn't assist in diagnosing the acute condition.
Laboratory results are normal except for mildly elevated eosinophils (780/mm³), suggesting atopy or eczema but not a direct link to the cough pattern.

Take-home points:

• Spasmodic croup is often triggered by allergies or viral irritants and is characterized by nighttime barking cough in toddlers.
• It should be differentiated from viral croup, RSV, and epiglottitis based on onset, symptoms, and physical findings.
• Clinical history from caregivers is crucial when physical signs are minimal or absent during examination.
• Absence of fever, normal labs, and clear lungs support non-infectious causes like spasmodic croup in an otherwise healthy child.