The client suffered cardiac arrest, was resuscitated and has now been on a ventilator for several days.
The client had a written advance directive which the spouse brought from home.
The primary care provider (PCP) is encouraging the spouse to consent for placement of a percutaneous endoscopic gastrostomy (PEG) tube, which is contrary to the client's advance directive.
After the PCP leaves, the spouse states, "I wish I knew what my spouse wanted.”. What is the best reply by the nurse?

Choice A rationale

Battery in a legal context refers to the intentional touching of another person without their consent. Inserting a urinary catheter into a client's urethra after the client has explicitly refused the procedure constitutes a non-consensual physical contact. Even if the procedure was ordered, the lack of consent transforms the act into battery, especially if it results in injury to the client.

Choice B rationale

Dereliction of duty, a component of negligence, involves a failure to meet the accepted standard of care. While inserting a catheter against a client's will could be seen as a failure in ethical and potentially professional standards, the specific tort of battery focuses on the unauthorized physical contact, regardless of whether it was done negligently or with intent to harm (though intent to touch without consent is present).

Choice C rationale

Assault involves an intentional act that creates a reasonable apprehension of immediate harmful or offensive contact. While the client may have felt threatened or apprehensive when the nurse proceeded despite their refusal, the actual insertion of the catheter and subsequent injury constitute battery, as physical contact occurred. Assault precedes battery; battery is the actual physical contact.

Choice D rationale

Invasion of privacy pertains to the wrongful intrusion into a person's private affairs or the public disclosure of private information. While a client has a right to privacy regarding their body and medical procedures, the act of physically inserting a catheter against their will, leading to injury, primarily constitutes a physical violation and lack of consent, which falls under the definition of battery.

Choice A rationale

Vitamin C is an important antioxidant and plays a role in collagen synthesis and immune function. While individuals with alcoholism may have poor nutrition and potential vitamin deficiencies, thiamine (vitamin B1) deficiency is a more immediate and critical concern due to its role in glucose metabolism and the risk of Wernicke-Korsakoff syndrome.

Choice B rationale

Thiamine deficiency is common in individuals with chronic alcoholism due to poor dietary intake, impaired absorption, and increased utilization of thiamine in metabolizing alcohol. Intramuscular administration ensures adequate absorption, and the frequency addresses the ongoing need to prevent or treat Wernicke-Korsakoff syndrome, a serious neurological disorder.

Choice C rationale

Magnesium deficiency is also common in alcoholics due to poor intake, increased urinary excretion, and gastrointestinal losses. While a one-time intravenous dose of magnesium sulfate can help replete levels and prevent complications like seizures, it does not address the chronic nature of the deficiency and the need for ongoing management.

Choice D rationale

Albumin is a plasma protein that can be low in individuals with chronic liver disease, which can be associated with alcoholism. However, a one-time infusion of albumin primarily addresses low oncotic pressure and fluid shifts and is not a standard initial treatment for alcoholism itself. Addressing thiamine deficiency is a more immediate priority to prevent neurological complications.