A nurse is discharging two clients from the hospital to their homes. The client with insurance will receive supplies to take home and the one without insurance will need to pick up supplies at the local community health department. The nurse should recognize that this is a breach of which of the following ethical principles?

Choice A reason: Limiting potassium intake is dangerous with digoxin, as low potassium (hypokalemia) increases the risk of digoxin toxicity by enhancing drug binding to cardiac cells. Adequate potassium levels are critical for safe use, as digoxin affects cardiac contractility, making this instruction incorrect and potentially harmful.
Choice B reason: Repeating a digoxin dose if the child vomits within 1 hour is unsafe without medical consultation, as it risks overdose. Digoxin has a narrow therapeutic index, and toxicity can cause arrhythmias. Parents should contact the provider for guidance, making this instruction incorrect and dangerous.
Choice C reason: Adding digoxin to juice risks inaccurate dosing, as the child may not consume the full amount, leading to underdosing or toxicity if additional doses are given. Precise administration (e.g., via syringe) ensures correct dosing, critical for digoxin’s narrow therapeutic range, making this instruction inappropriate.
Choice D reason: Having the child drink water after digoxin ensures the dose is fully swallowed, preventing loss from spitting or incomplete ingestion. This supports accurate dosing, essential for digoxin’s safe use in heart failure, where it enhances cardiac output. This instruction is safe and effective, making it correct.

Choice A reason: Thinking about wanting the procedure shows indecision, not consent understanding. Informed consent requires comprehension of the procedure, risks, and benefits, ensuring voluntary agreement. Contemplation alone is incomplete, failing to confirm the client’s grasp of the consent form’s legal purpose.
Choice B reason: Stating that signing indicates permission reflects understanding of informed consent, which documents voluntary agreement after receiving procedure details, risks, and benefits. This aligns with ethical and legal standards, confirming the client’s comprehension of the consent form’s role in authorizing surgery.
Choice C reason: Asking about risks indicates engagement but not consent understanding. It suggests a need for more information, not confirmation of the form’s purpose. While important, it does not reflect comprehension of the consent process as clearly as acknowledging the act of signing.
Choice D reason: Wanting to discuss concerns with the doctor shows the client seeks clarification, not that they understand the consent form’s purpose. It indicates an ongoing process, not confirmation of the form’s role in granting permission, unlike acknowledging the signing’s significance.