A nurse is caring for patients receiving clozapine, lithium, fluoxetine, and venlafaxine. Which patient should the nurse be most alert for problems associated with fluid and electrolyte imbalance?

Choice A reason: Autonomy involves respecting a patient’s right to make decisions. While relevant in mental health, the scenario focuses on differing treatments for similar conditions, not patient choice, making autonomy less directly applicable than the principle of fair treatment across patients.

Choice B reason: Beneficence emphasizes promoting patient well-being. Both restraints and supervision aim to prevent harm, fulfilling beneficence, but the concern is about unequal treatment, not the intent to benefit, making this principle less relevant than justice.

Choice C reason: Justice involves fair and equitable treatment for all patients. Using restraints for one self-mutilating patient and supervision for another raises concerns about consistency and fairness in care, directly aligning with the ethical principle of justice, making this the correct choice.

Choice D reason: Nonmaleficence focuses on avoiding harm. Both interventions aim to prevent self-mutilation, fulfilling this principle, but the ethical issue is about equitable application, not harm avoidance, making justice the more relevant principle in this scenario.

Choice A reason: Trust versus mistrust occurs in infancy (0–1 year), focusing on trust in caregivers. Failure leads to suspicion, not regret over life accomplishments. This stage is irrelevant to a 52-year-old’s reflections on life achievements, making this choice incorrect for the described crisis.

Choice B reason: Generativity versus stagnation (middle adulthood, 40–65 years) involves contributing to society versus feeling unproductive. While related, the woman’s regret over past accomplishments aligns more with reflecting on life’s meaning, typical of a later stage, making this choice less precise.

Choice C reason: Integrity versus despair (late adulthood, 65+ years, but relevant in late middle age) involves reflecting on life’s achievements. Failure leads to despair and regret, matching the woman’s statement about unaccomplished goals, making this the correct choice for her psychosocial crisis.

Choice D reason: Industry versus inferiority (6–12 years) focuses on competence in tasks. Failure leads to feelings of inadequacy in skills, not regret over life’s broader accomplishments. This stage is irrelevant to the woman’s current reflections, making this choice incorrect.