The nurse enters the room of a client with a Clostridium difficile infection to administer an IV antibiotic. The unlicensed assistive personnel (UAP) is in the room cleaning the client’s buttocks and reports the client has been incontinent with diarrhea. The UAP is wearing gloves but not a gown. Which action should the nurse implement first?

Choice A reason: Veracity involves truthfulness, which is not the primary principle here. The nurse manager’s suggestions about support systems empower the staff member to seek help independently, emphasizing autonomy. Veracity would apply if the manager ensured honest communication, but the focus is on enabling self-directed action, not truth-telling.

Choice B reason: Autonomy is encouraged by suggesting support systems, empowering the staff member to make independent choices about managing personal issues. This principle respects the individual’s right to self-determination, aligning with ethical nursing practice. The manager’s guidance fosters decision-making, enabling the staff member to address emotional challenges proactively.

Choice C reason: Fidelity involves keeping promises or loyalty, which is not the focus. The nurse manager’s action centers on empowering the staff member to seek support, promoting autonomy. Fidelity would apply if the manager committed to ongoing support, but the emphasis is on enabling independent action, not obligation.

Choice D reason: Justice ensures fairness, which is irrelevant here. The nurse manager’s suggestions promote autonomy by encouraging the staff member to choose support systems. Justice would apply in equitable resource allocation, but this scenario focuses on individual empowerment, making autonomy the principle being encouraged by the manager’s actions.

Choice A reason: Washing with soap and water cleanses the skin, removing dirt, oils, and bacteria that could interfere with ointment absorption or cause infection. This method ensures a clean, intact surface, optimizing the medication’s efficacy. It is the standard, evidence-based preparation for topical administration, promoting safety and therapeutic effect.

Choice B reason: Cleansing with an alcohol prep pad is suitable for injections but may dry or irritate skin before ointment application. Alcohol removes natural oils, potentially reducing ointment absorption. Soap and water provide thorough cleansing without compromising skin integrity, making this a less appropriate method for topical medication preparation.

Choice C reason: Shaving excess hair may improve ointment contact but risks micro-abrasions, increasing infection risk. It is unnecessary unless hair significantly obstructs application. Washing with soap and water is sufficient to prepare the skin, ensuring cleanliness and safety without the potential complications associated with shaving.

Choice D reason: Gently massaging the area may enhance circulation but does not clean the skin, risking contamination or reduced ointment efficacy. Soap and water remove barriers to absorption, like oils or debris. Massage is not a standard preparation step, making it ineffective compared to thorough cleansing for topical administration.