A hospice nurse is visiting with the son of a client who has terminal cancer.

The son reports sleeping very little during the past week due to caring for his mother.

Which of the following responses should the nurse make?

The correct answer is A. Beneficence. Beneficence is the ethical principle of doing good for the patient and promoting their well-being.

The nurse is demonstrating beneficence by sitting with the client to provide comfort and support during a difficult time.

Choice B is wrong because fidelity is the ethical principle of keeping promises to the patient and being loyal and faithful.

The nurse is not making or keeping any promises to the client in this scenario.

Choice C is wrong because autonomy is the ethical principle of respecting the patient’s right to make their own decisions and choices.

The nurse is not interfering with the client’s autonomy in this scenario.

Choice D is wrong because veracity is the ethical principle of telling the truth to the patient and being honest and trustworthy.

The nurse is not lying or withholding information from the client in this scenario.

The correct answer is choice C: “Do you have thoughts of harming yourself?”.

This is the priority question for the nurse to ask the client because it assesses the client’s risk for suicide, which is a serious and potentially life-threatening complication of conduct disorder. The nurse should use a direct and nonjudgmental approach when asking about suicidal ideation and plan.

Choice A: “How do you get along with your peers at school?” is wrong because it is not the most urgent question to ask the client.

While it is important to assess the client’s social relationships and possible peer rejection, this can be done after addressing the client’s safety and mental status.

Choice B: “Do you have a criminal record?” is wrong because it is not relevant to the client’s current condition and might make the client feel defensive or stigmatized.

The nurse should avoid asking questions that imply blame or judgment and focus on the client’s strengths and coping skills.

Choice D: “How do you manage your behavior?” is wrong because it is not appropriate for the nurse to ask the client in an emergency department setting.

This question might imply that the client is responsible for their conduct disorder, which is a complex and multifactorial mental health condition. The nurse should collaborate with the client and their family to develop a behavior management plan that involves positive reinforcement, limit setting, and consistent consequences.

Normal ranges: According to the DSM-5, conduct disorder is characterized by a persistent pattern of behavior that violates the rights of others or societal norms.

The symptoms of conduct disorder include aggression, deceitfulness, destruction of property, serious rule violations, and lack of remorse.

Conduct disorder can cause significant impairment in social, academic, or occupational functioning. The prevalence of conduct disorder is estimated to be 4% among children and adolescents.

The risk factors for conduct disorder include genetic factors, neurobiological factors, environmental factors, and psychological factors.