A nurse is working with a client who becomes combative and threatens other clients and staff. Which of the following actions should the nurse take?

Choice A reason: Fidelity is keeping promises and maintaining trust, as the nurse commits to walking daily with the client. This builds therapeutic reliability, reducing anxiety through consistent support, aligning with ethical standards where honoring commitments fosters psychological safety and strengthens the nurse-patient relationship scientifically.

Choice B reason: Justice involves fair resource distribution, not individual promises like walking with a client. This scenario focuses on personal commitment, not equity among patients. Ethically, justice applies to systemic fairness, lacking relevance to this specific supportive action grounded in trust-building principles.

Choice C reason: Nonmaleficence means avoiding harm, but promising to walk exceeds mere harm prevention, aiming to alleviate anxiety actively. While it supports well-being, it’s not the primary principle here. Scientifically, this is more about trust than just safety, distinguishing it from nonmaleficence’s core intent.

Choice D reason: Autonomy respects client decisions, but the nurse’s promise is her initiative, not the client’s choice. It supports, not directs, independence. Ethically, autonomy focuses on self-determination, whereas this action reflects commitment, making fidelity the more fitting principle in this scenario.

Choice A reason: Remeasuring confirms the 190/110 mm Hg reading, ensuring accuracy in kidney failure, where hypertension is common. It’s the first step before acting.

Choice B reason: Administering medication without verification risks error; BP may be inaccurate. In kidney failure, precise BP guides therapy, so this waits.

Choice C reason: Reporting to the charge nurse follows confirmation; unverified readings waste time. Accuracy in chronic kidney failure is critical before escalating.

Choice D reason: Bed rest may help, but confirming BP first prioritizes data. Kidney failure needs validated hypertension readings to direct immediate care safely.