A nurse is reinforcing teaching with a client who uses a nitroglycerine patch to treat angina. The client now has a new prescription for nitroglycerin sublingual tablets. Which of the following instructions should the nurse include?

A) Justice:
The principle of justice refers to the fair and equitable distribution of resources and the fair treatment of individuals. While it is an important ethical principle in healthcare, it does not specifically address the concept of avoiding harm to the client.

B) Fidelity:
Fidelity, also known as loyalty or faithfulness, relates to the obligation of healthcare professionals to be faithful to the commitments and promises they make to their clients. While fidelity is important for building trust and maintaining professional relationships, it does not directly address the concept of avoiding harm.

C) Non-maleficence:
Non-maleficence is the ethical principle that refers to the duty to do no harm. It emphasizes the obligation to protect clients from harm by ensuring that no unnecessary or unjustified harm is inflicted. In the context of healthcare, non-maleficence guides healthcare professionals to prioritize the safety and well-being of their clients, avoiding actions or interventions that may cause harm. This is the correct choice.

D) Beneficence:
Beneficence is the ethical principle that emphasizes the duty to do good and promote the well-being of others. While it is related to the concept of providing positive benefits to clients, it does not specifically focus on the avoidance of harm.

(A) "I’ll breathe deeply and cough every 4 hours."
Deep breathing and coughing exercises should be done more frequently, typically every 1-2 hours while awake, to help prevent respiratory complications such as atelectasis and pneumonia.

(B) "I’ll splint my incision with a pillow to cough."
This statement indicates an understanding of the instructions. Splinting the incision with a pillow helps support the surgical site, reduces pain, and makes coughing more effective and less uncomfortable. This technique is important for clients to use to help clear secretions from the lungs postoperatively.

(C) "I’ll start to use the incentive spirometer when I can get out of bed."
The use of an incentive spirometer should begin as soon as possible, usually while the client is still in bed, to encourage deep breathing and prevent postoperative respiratory complications. It should not be delayed until the client can get out of bed.

(D) "I’ll lie flat in bed to cough and deep breathe."
Lying flat is not the optimal position for deep breathing and coughing exercises, as it can make it more difficult to fully expand the lungs. The client should be positioned with the head of the bed elevated or sitting up to facilitate better lung expansion and more effective coughing.