A public health nurse is planning a prenatal program to ensure that resources are equally available to all community members. Which of the following ethical principles is the nurse practicing?

Rationale:

A. "You will receive a dose of misoprostol to initiate contractions.": Misoprostol is used for cervical ripening and induction of labor, not for a contraction stress test. A CST uses nipple stimulation or low-dose oxytocin to produce mild contractions. Using misoprostol would create strong, prolonged contractions that could endanger the fetus.

B. "I will apply an external fetal heart rate monitor during the test.": A contraction stress test evaluates how the fetal heart rate responds to contractions. External fetal monitoring is required to record the fetal heart pattern and contraction frequency, allowing the provider to assess for late decelerations that indicate uteroplacental insufficiency. This reflects accurate and essential teaching for the procedure.

C. "I will give you a terbutaline injection after the test.": Terbutaline is a tocolytic used to stop contractions, but it is not routinely administered after a CST. The contractions produced during a CST are mild and temporary, and terbutaline is only given if excessive contractions occur, which is not expected in normal testing.

D. "I will apply an oxygen face mask during the test.": Oxygen is not routinely administered during a CST because the goal is to observe how the fetus tolerates normal physiologic contractions. Oxygen is used only if fetal distress occurs, so including it in routine teaching suggests an incorrect understanding of the procedure.

Rationale:

A. Use gauze to secure an arm board to the involved extremity: Using gauze alone to secure an arm board is not recommended for a PICC line, as it can cause pressure, restrict circulation, and does not provide adequate stabilization. Specialized securement devices or adhesive dressings are preferred to maintain catheter integrity and prevent complications.

B. Measure the arm circumference above the insertion site daily: Daily measurement of the arm circumference helps detect early signs of swelling, infiltration, or thrombophlebitis, which are potential complications of PICC lines. Monitoring for changes allows prompt intervention and helps ensure safe catheter function.

C. Schedule an MRI postprocedure to verify placement: MRI is not used to verify PICC placement. Catheter tip placement is typically confirmed with chest X-ray or fluoroscopy immediately after insertion, which is the standard method for ensuring correct placement in the superior vena cava.

D. Administer sedation for the procedure: PICC line insertion is generally performed under local anesthesia, not systemic sedation. Routine sedation is not indicated for this minimally invasive procedure unless the client has severe anxiety or special considerations, making it unnecessary in standard care.