A nurse is planning to apply a transdermal analgesic cream prior to inserting an IV for a preschool-age child. Which of the following actions should the nurse plan to take? (Select all that apply)

Answer: D

Rationale:

A. "Drink 400 ml every hour until bowel movements are clear": The standard recommendation for PEG is to drink a specific volume, usually 240 ml every 10 to 15 minutes, rather than 400 ml every hour. The goal is to ensure the bowel is adequately cleansed, and this rate is typically more effective in achieving that.

B. "Expect bowel movements to begin 3 hr following completion of solution": Bowel movements often start within an hour or two after starting the PEG solution rather than waiting for 3 hours after finishing it. The timing can vary, but the onset is generally sooner.

C. "To prevent dehydration, drink an additional liter of fluid during preparation time": While it is important to stay hydrated, the specific recommendation for additional fluid intake beyond the PEG solution can vary. Typically, the instructions focus on the volume of PEG solution to drink rather than specifying a set amount of additional fluid.

D. "Abdominal bloating might occur": Abdominal bloating is a common side effect of bowel cleansing preparations like PEG. It can occur due to the large volume of fluid ingested and the rapid movement of the bowel contents, making it a relevant point to include in the instructions.

A. Fidelity: Fidelity refers to the duty to fulfill one's commitments and obligations. While important in nursing practice, fidelity is not directly applicable to the decision not to administer pain medication in this scenario.
B. Veracity: Veracity refers to truthfulness and honesty in communication. While it is important for the nurse to communicate honestly with the client and their family about the risks and benefits of pain management, the decision not to administer pain medication is primarily based on the principle of non-maleficence.
C. Utilitarianism: Utilitarianism is an ethical theory that emphasizes the greatest good for the greatest number of people. While pain relief may contribute to the overall well-being of the client, the decision not to administer pain medication in this scenario is more closely aligned with the principle of non-maleficence, as it focuses on avoiding harm to the individual client.
D. Non-maleficence: Non-maleficence is the ethical principle that emphasizes the duty to do no harm. In this situation, the nurse's primary concern is to avoid causing harm to the client. Administering pain medication to relieve suffering, even if it might hasten death, aligns with the principle of non-maleficence because the intent is to alleviate suffering and provide comfort to the dying client.