A charge nurse provides an annual in-service for the nursing staff regarding ethical practice. Which of the following actions should the nurse include as an example of ethical practice?
A nurse raises all four side rails on the bed of a client who is confused.
A nurse administers prescribed opioids to a client who has a terminal illness and respiratory rate of 8/min.
A nurse elects not to care for a client who had an abortion.
A nurse withholds nutrition from a client who has a do-not-resuscitate (DNR) order.
The Correct Answer is B
A. Raising all four side rails on a confused client’s bed is considered a restraint and violates the principle of autonomy. Restraints should only be used as a last resort and require a provider’s order. Ethical practice involves finding less restrictive alternatives, such as using a sitter or bed alarms.
B. Administering opioids to a terminally ill client, even with a low respiratory rate, aligns with ethical nursing principles such as beneficence (relieving suffering) and nonmaleficence (preventing harm) when used for palliative care. In end-of-life care, the priority is comfort, and pain management is considered ethical even if it may impact respiration. This aligns with the principle of double effect, which justifies an action intended for good (pain relief) even if it has potential negative side effects (respiratory depression).
C. Electing not to care for a client due to personal beliefs is an example of bias and does not adhere to the ethical principle of fidelity, which requires nurses to provide care regardless of personal beliefs.
D. Withholding nutrition from a client with a DNR order is not ethical unless there is a clear directive regarding the client's wishes, and it may cause harm.
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Correct Answer is C
Explanation
A. It is the provider's responsibility, not the nurse's, to disclose the expected outcomes, risks, and alternatives of a treatment. The nurse ensures the client understands what was explained, but does not disclose this information themselves.
B. While consent allows nurses to perform interventions, the primary responsibility for obtaining informed consent lies with the provider who is performing the procedure.
C. The nurse's signature on the consent form signifies that they witnessed the client sign the document and that the client appeared competent and gave voluntary consent. This is the correct role of the nurse in the informed consent process.
D. Informed consent must be written for procedures, although verbal consent can be used for some less invasive treatments, but this is not standard for most medical or surgical procedures.
Correct Answer is C
Explanation
A. A decrease in HDL (high-density lipoprotein) is unrelated to insulin administration and would not indicate effective teaching about insulin use.
B. An increase in blood glucose levels would suggest poor glycemic control, indicating that the teaching method was ineffective in helping clients manage their insulin properly.
C. A decrease in HbA1C levels reflects better long-term blood sugar control and indicates that the new method of teaching insulin administration is effective in helping clients manage their diabetes.
D. An increase in incidents of lipohypertrophy suggests improper insulin injection technique, indicating that the teaching method was ineffective.
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