A nurse is caring for a client whose partner recently died.

The nurse sits with the client to provide comfort.

Which of the following ethical principles is the nurse demonstrating?

Choice A reason:

Completing an incident report is not the correct action. An incident report should be completed as part of the hospital's protocol to document the medication error and ensure appropriate follow-up and investigation.

Choice B reason:

Checking the client for indications of bleeding is the correct action to be taken. In this situation, the nurse's first priority should be to assess the client for indications of bleeding, as the client received a significantly higher dose of IV heparin than prescribed. Heparin is an anticoagulant medication used to prevent blood clots, and an overdose can increase the risk of bleeding.

After administering the wrong dose of medication, the nurse's immediate concern is the client's safety and well-being. Checking for signs of bleeding, such as petechiae, ecchymosis, hematomas, bleeding gums, melena (black, tarry stools), haematuria (blood in urine), or any other unusual bleeding, is crucial.

Choice C reason:

Monitor the client's aPTT levels: This is not the correct action to be taken. Monitoring the client's activated partial thromboplastin time (aPTT) levels is essential to assess the client's coagulation status and determine if the overdose of heparin has affected their clotting ability. The healthcare provider may adjust the heparin dosage based on the aPTT levels.

Choice D reason:

Notify the risk manager: This is not the correct action to be taken. The risk manager or appropriate supervisor should be informed about the medication error as soon as possible to initiate a thorough review of the incident and take necessary steps to prevent similar errors in the future.

The correct answer is choice CDE.

Choice A rationale:

Eating fish for dinner at least twice per week is not specifically recommended for pancreatitis patients. A low-fat diet is generally advised, but the frequency of fish consumption is not a key point in discharge teaching.

Choice B rationale:

Limiting coffee intake is not a primary focus in pancreatitis discharge instructions. While caffeine can irritate the digestive system, the emphasis is more on avoiding alcohol and fatty foods.

Choice C rationale:

Eating small, frequent meals is recommended to avoid overloading the digestive system and to help manage symptoms of pancreatitis.

Choice D rationale:

Pale bowel movements can indicate a problem with bile flow, which is not a normal expectation for pancreatitis patients. This could suggest a complication that needs medical attention.

Choice E rationale:

Dark urine can be a sign of dehydration or liver issues, which should be reported to a healthcare provider as it may indicate a complication.