A nurse is caring for an older adult client who has a terminal illness and is ventilator dependent. The client is alert and oriented and he wants to discontinue use of the ventilator. The nurse should be aware that continued treatment against the client’s wishes is a violation of which of the following ethical principles?

Choice A reason: Flexing the upper and extending the lower extremities in response to the painful stimulus is not an expected response for a client who has a traumatic head injury. This is a sign of decorticate posturing, which indicates damage to the cerebral hemispheres or the internal capsule. Decorticate posturing is a type of abnormal flexion that involves the abduction of the arms, internal rotation of the shoulders, flexion of the wrists, and extension of the legs.

Choice B reason: Pushing the painful stimulus away is not an expected response for a client who has a traumatic head injury. This is a sign of normal motor function, which indicates that the client can localize and withdraw from the painful stimulus. This is the highest level of motor response on the Glasgow Coma Scale (GCS), which is a neurological scoring system used to assess conscious level after head injury.

Choice C reason: Extending the body toward the painful stimulus is an expected response for a client who has a traumatic head injury. This is a sign of decerebrate posturing, which indicates damage to the brainstem or midbrain. Decerebrate posturing is a type of abnormal extension that involves the abduction of the arms, external rotation of the shoulders, extension of the wrists, and extension of the legs.

Choice D reason: Showing no reaction to the painful stimulus is not an expected response for a client who has a traumatic head injury. This is a sign of flaccid paralysis, which indicates damage to the spinal cord or peripheral nerves. Flaccid paralysis is a type of complete loss of muscle tone and reflexes that involves the absence of any voluntary or involuntary movements.

Choice A reason: Hypotension is not a common manifestation of ARF. Hypotension is a low blood pressure, defined as less than 90/60 mm Hg. Hypotension can have many causes, such as dehydration, blood loss, heart problems, or medications. ARF does not directly cause hypotension, but it can lead to complications such as shock or organ failure, which can lower the blood pressure.

Choice B reason: Decreased level of consciousness is a frequent manifestation of ARF. Decreased level of consciousness is a state of impaired awareness, orientation, memory, or judgment. Decreased level of consciousness can occur in ARF due to several factors, such as hypoxia, hypercapnia, acidosis, or infection. The nurse should monitor the mental status of the client with ARF and report any changes to the provider.

Choice C reason: Severe dyspnea is a common manifestation of ARF. Dyspnea is a subjective sensation of difficulty breathing or shortness of breath. Severe dyspnea can occur in ARF due to the reduced oxygen delivery or increased carbon dioxide retention in the blood. The nurse should assess the respiratory rate, rhythm, depth, and effort of the client with ARF and provide oxygen therapy as prescribed.

Choice D reason: Headache is not a typical manifestation of ARF. Headache is a pain or discomfort in the head, scalp, or neck. Headache can have many causes, such as stress, dehydration, sinusitis, or migraine. ARF does not directly cause headache, but it can cause increased intracranial pressure or cerebral edema, which can trigger headache.

Choice E reason: Nausea is not a usual manifestation of ARF. Nausea is a feeling of sickness or discomfort in the stomach that can lead to vomiting. Nausea can have many causes, such as food poisoning, motion sickness, pregnancy, or medications. ARF does not directly cause nausea, but it can cause gastrointestinal bleeding or hepatic encephalopathy, which can induce nausea.