A nurse in a clinic is caring for a client who is pregnant and asks how she should help her 4-year-old son prepare for the new baby. Which of the following statements should the nurse make?

Rationale for correct choices:

• Opioid intoxication: The client's decreased respiratory rate, drowsiness, pinpoint pupils, and positive response to naloxone are all indicative of opioid intoxication. These features, along with the presence of a needle in the antecubital space, strongly support recent opioid use and CNS depression.
• Pupil characteristics: Miotic pupils, or pinpoint pupils, are a classic physical sign of opioid intoxication. They occur due to opioid stimulation of the parasympathetic nervous system, and in a sedated client with a history of injection drug use, they confirm the likelihood of opioid overdose.

Rationale for incorrect choices:

• Alcohol intoxication: Alcohol intoxication usually presents with disinhibition, unsteady gait, slurred speech, and potentially aggressive or inappropriate behavior. The client’s severe sedation, low respiratory rate, and constricted pupils are not typical features of alcohol intoxication, especially with only one beer reported.
• Alcohol withdrawal: Alcohol withdrawal manifests with symptoms like tremors, agitation, hallucinations, seizures, and autonomic instability (tachycardia, hypertension). This client is sedated with bradypnea and hypotension, which are incompatible with alcohol withdrawal and more suggestive of CNS depression.
• Opioid withdrawal: Opioid withdrawal is marked by agitation, anxiety, mydriasis, vomiting, diarrhea, and piloerection. In contrast, this client is drowsy, has decreased bowel sounds, and constricted pupils, pointing toward active opioid intoxication rather than withdrawal.
• Amount of alcohol consumed: The report from EMS indicates the client consumed only one beer, which is insufficient to explain the severity of the symptoms. Minimal alcohol intake also makes both intoxication and withdrawal from alcohol highly unlikely as the primary issue.
• Current temperature: The client’s current temperature of 37.2°C (99°F) is within normal limits and does not support any particular diagnosis. It neither confirms nor excludes opioid or alcohol intoxication or withdrawal and is not a defining clinical sign in this context.
• Breath sounds: Breath sounds are equal and clear, offering no abnormal findings to support or contradict a diagnosis. While important for general assessment, they are not specific indicators for opioid intoxication or withdrawal and thus are less relevant than pupil changes.

Rationale:

A. Veracity: Veracity involves telling the truth and providing accurate information. While important in building trust, it is not the ethical principle most relevant to offering emotional presence during grief.

B. Fidelity: Fidelity refers to being faithful to promises and responsibilities, including maintaining confidentiality and following through on care. It does not specifically reflect the act of offering comfort in grief.

C. Beneficence: Beneficence is the act of doing good and promoting the well-being of others. By sitting with the grieving client to provide comfort, the nurse is demonstrating compassion and aiming to alleviate suffering.

D. Autonomy: Autonomy refers to respecting a client’s right to make their own decisions regarding care. While essential in healthcare, it does not directly relate to the nurse’s compassionate presence during bereavement.