A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to “end it all.” The client decides they want to leave against medical advice. Which of the following would be the most appropriate action by the nursing staff?

Choice A reason: Releasing the client when behavioral control is achieved aligns with autonomy and beneficence, not nonmaleficence. While it benefits the client, it does not directly address harm prevention, which is the core of nonmaleficence. The focus is on restoring freedom, not specifically ensuring no physical harm during restraint use.

Choice B reason: Explaining release requirements promotes understanding and autonomy but does not directly prevent harm, the focus of nonmaleficence. It supports therapeutic communication but does not address the physical safety risks of restraints, such as skin breakdown or circulation issues, making it less relevant to this principle.

Choice C reason: Applying restraints based on assessment, not attitude, ensures objectivity, aligning with justice and fairness. While this prevents inappropriate restraint use, it is less directly tied to nonmaleficence, which focuses on avoiding harm like injury during restraint application, making it a secondary consideration in this context.

Choice D reason: Assuring restraints do not cause injury directly upholds nonmaleficence, the ethical principle of avoiding harm. Regular checks for skin breakdown, circulation impairment, or nerve damage prevent physical harm, ensuring safety during restraint use, making this action the most aligned with nonmaleficence in a restrained client.

Choice A reason: Hypertension and obesity (BMI 30) are major risk factors for ESRD. Chronic hypertension damages renal vasculature, reducing glomerular filtration over time. Obesity exacerbates hypertension and promotes glomerulosclerosis, leading to progressive kidney damage. This combination significantly increases the risk of developing ESRD through sustained renal injury.

Choice B reason: Vascular disorders, such as atherosclerosis, impair renal blood flow, causing ischemic nephropathy. Chronic reduced perfusion damages nephrons, leading to progressive renal failure. Vascular diseases also contribute to hypertension, further stressing kidneys. This client’s history indicates a high risk for ESRD due to ongoing vascular compromise affecting renal function.

Choice C reason: Poorly controlled diabetes mellitus causes diabetic nephropathy, a leading cause of ESRD. Chronic hyperglycemia damages glomerular capillaries, leading to proteinuria and declining kidney function. Sustained high glucose levels accelerate nephron loss, making this client at high risk for ESRD due to irreversible renal damage from diabetes.

Choice D reason: Chronic obstructive pulmonary disease (COPD) primarily affects the lungs, not the kidneys. While hypoxia or medications like corticosteroids may indirectly stress kidneys, COPD is not a direct risk factor for ESRD. Renal damage requires specific insults like hypertension or diabetes, making this client less likely to develop ESRD.

Choice E reason: A recent dehydration episode from gastroenteritis can cause acute kidney injury but is reversible with treatment. It is not a chronic condition leading to ESRD unless recurrent or combined with other risk factors like diabetes or hypertension. This isolated event poses a lower risk for ESRD development.