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Fidelity: Fidelity refers to the responsibility to maintain trust and uphold promises made to clients. While important, the core issue in this case is not about fulfilling prior commitments but rather about responding truthfully to a direct question from the adolescent regarding their medical condition.

Authority: Authority is the recognized power to make decisions or enforce obedience, typically within a professional or legal framework. In this situation, the ethical dilemma is not related to decision-making power but centers on the nurse's obligation to provide honest communication.

Justice: Justice emphasizes fairness and equitable treatment of all clients in healthcare settings. Although justice is critical to ethical practice, the specific challenge here involves answering truthfully when asked about a relapse, rather than issues of equitable treatment or distribution of care.

"A client must sign an Against Medical Advice form if he withdraws consent.": An Against Medical Advice (AMA) form is specifically used when a client chooses to leave a healthcare facility against medical advice, not when they withdraw consent for a procedure. Withdrawing consent does not require an AMA form and follows a separate legal and ethical process.

"A client who is involuntarily admitted to a mental health unit cannot withdraw consent for treatment.": Even clients who are involuntarily admitted retain certain rights, including the right to refuse specific treatments unless they are legally deemed incompetent or pose an imminent threat. Involuntary admission does not mean automatic consent to all treatments.

"A client must provide a written refusal for a procedure for which he has already signed an informed consent.": Clients can verbally withdraw consent at any time; a written refusal is not legally required. While documentation of the client's decision is necessary for the medical record, insisting on a written refusal is not a legal prerequisite for withdrawal of consent.

Document an incident report in a client's medical record: Incident reports are essential for internal documentation but should not be placed in the client’s medical record. Including them in the medical record can lead to legal complications. This action addresses individual events rather than contributing to systematic quality improvement efforts.

Notify the provider if a client falls: Notifying the provider about a fall is a necessary clinical step to ensure immediate evaluation and care for the client. However, simply informing the provider does not contribute directly to a quality improvement initiative aimed at analyzing and reducing overall fall rates.

Assist with the care of a client who has fallen: Providing immediate care after a fall is crucial to ensure client safety and manage injuries. However, assisting after the fall focuses on acute clinical response rather than on proactive measures to identify trends and reduce the incidence of future falls.

A client who is displaying aggression: Using a gait belt on an aggressive client is unsafe because sudden movements or resistance could lead to injury for both the client and the caregiver. Aggressive behavior requires de-escalation strategies before considering physical assistance or mobility interventions like a gait belt.

A client who has had chest trauma: Gait belts should be avoided in clients with chest trauma because the pressure applied around the torso can exacerbate injuries such as rib fractures, pulmonary contusions, or other thoracic complications, posing significant health risks during mobilization.

A client who has a thoracic incision: Applying a gait belt over or near a thoracic incision can interfere with wound healing, cause pain, and increase the risk of wound dehiscence. Alternative methods for assisting mobility should be used for clients with fresh surgical sites in the thoracic region.

Anorexia: Anorexia, or loss of appetite, is not a typical adverse effect directly associated with heparin use. While it may occur due to general postoperative factors, it is not an urgent or life-threatening reaction that necessitates immediate reporting related to anticoagulant therapy.

Weight gain: Weight gain could suggest fluid retention, but it is not a typical adverse effect of heparin. While postoperative clients should be monitored for signs of fluid imbalance, sudden bleeding signs like epistaxis are far more critical to recognize and report when administering anticoagulants.

Bradycardia: Bradycardia, or slow heart rate, is not commonly linked to heparin therapy. While abnormal heart rhythms may occur postoperatively for other reasons, they are not typically associated with bleeding risks from heparin and thus do not require urgent reporting specific to heparin use.

Urinary catheter: A urinary catheter is not routinely required for infants with a spica cast. Unless there are specific urinary retention issues or surgical complications, normal voiding is expected, and a catheter would introduce unnecessary risk for infection.

Wound vac: A wound vac is used for complex wound management involving significant drainage or delayed healing. Infants with a spica cast typically do not have open wounds that necessitate negative pressure wound therapy, making this equipment unnecessary for discharge.

Feeding pump: A feeding pump is typically used for clients requiring continuous enteral feeding. Unless the infant has a separate feeding disorder or gastrointestinal complication, feeding by mouth is expected, and a feeding pump would not be standard discharge equipment.

"I limit my time spent out in the sunlight.": While moderate sun exposure can be beneficial for psoriasis, excessive sun exposure can worsen the condition or increase the risk of skin cancer. Limiting sunlight is generally a safe practice unless the client is avoiding it entirely, which is not indicated here.

"I remove old medication on my skin before applying a new dose.": Proper application of topical medications includes cleaning old residue to promote better absorption of the new dose. This practice is appropriate and demonstrates an understanding of correct medication use.

"I do not use fabric softener when I wash my clothing.": Avoiding fabric softeners is a helpful strategy for clients with psoriasis because softeners can leave residues that irritate sensitive skin. This statement reflects good self-care behavior rather than a concern needing provider intervention.

Place the client in a supine position: A supine position can impair lung expansion and increase the risk of respiratory complications. Clients with a chest tube are best positioned in a semi-Fowler’s or high-Fowler’s position to promote lung re-expansion and ease of breathing.

Empty the collection chamber every 8 hr: The collection chamber in a chest drainage system should not be emptied routinely, it should be emptied as needed to prevent it from overfilling. It is a closed system, and breaking it by emptying can introduce infection or disrupt the pressure needed for effective drainage.

Clamp the chest tube every 4 hr: Routine clamping of a chest tube is not recommended as it can lead to a dangerous buildup of air (tension pneumothorax). Clamping is reserved for specific, short-term procedures under direct provider orders, such as changing the drainage system.

"If I decide to get implants in my arm, I will get them replaced every 10 years.": Contraceptive implants, such as etonogestrel (Nexplanon), typically last about 3 to 5 years, not 10 years. Misunderstanding the replacement timeline could leave a client unprotected against pregnancy if not corrected.

"If I decide to get pregnant again, tubal reconstruction is a reliable option.": Tubal ligation is considered a permanent form of contraception. Although tubal reversal surgery exists, it is not always successful and is not a reliable or guaranteed method for restoring fertility.

"If I get an IUD placed, I will not have menstrual bleeding.": Some types of IUDs, particularly hormonal IUDs, may reduce menstrual bleeding significantly, but complete absence of bleeding does not occur in all clients. Copper IUDs, in contrast, may actually increase menstrual bleeding and cramping.

Clamp the urinary catheter tubing: Clamping the catheter tubing is not appropriate because it can lead to bladder distention, increased pressure, and risk of bladder rupture. Maintaining continuous drainage is essential to prevent complications following prostate surgery.

Replace the indwelling urinary catheter with a smaller diameter catheter: Replacing the catheter is not the first intervention when clots and dark red blood are present. Smaller diameter catheters would actually be less effective in clearing clots and could worsen the blockage.

Allow the tubing to hang below the drainage bag: The drainage tubing should always be positioned above the collection bag to maintain gravitational drainage. Letting the tubing hang below the bag would impair drainage and could lead to backflow and infection.

Reviewing the results of the client's celiac screening with their parents, without the client's consent: Celiac screening relates to general medical conditions and nutritional health, which are typically shared with parents of minors unless otherwise restricted. This does not generally breach confidentiality because it is not considered sensitive under adolescent health privacy laws.

Reviewing the results of the client's complete blood count (CBC) with their parents, without the client's consent: A CBC is a routine diagnostic test that checks general health indicators such as anemia or infection. Discussing these results with parents, especially for minors, is standard practice and does not usually violate confidentiality.

Reviewing the results of the client's urinalysis with their parents, without the client's consent: Urinalysis results typically assess general health or identify infections, which are standard to share with parents in the care of minors. This action would not be considered as a breach of confidentiality unless it revealed sensitive information like substance use without consent.

Serosanguinous drainage on dressing: Serosanguinous drainage, which is a mixture of clear and blood-tinged fluid, is a common and expected finding in the early postoperative period. It typically indicates normal healing unless the amount becomes excessive or the drainage changes character.

Hypoactive bowel sounds: Hypoactive bowel sounds are common within the first 24 to 48 hours following surgery, especially after general anesthesia or abdominal procedures. This finding is expected and does not immediately require provider notification unless accompanied by other concerning signs like severe abdominal distention.

Pain level of 2 on 0 to 10 scale: A pain score of 2 indicates mild pain, which is manageable and expected after surgery. This level of discomfort does not require urgent reporting to the provider as long as it remains controlled and does not interfere with recovery activities.

"I will take my inhaler treatment before each meal and at bedtime.": Budesonide is a corticosteroid used for long-term control of asthma, not for timing around meals. It is usually taken at set times daily to maintain airway inflammation control, not specifically related to mealtimes or bedtime alone.

"I should use my inhaler before exercising.": Using an inhaler before exercise is a strategy typically applied to short-acting bronchodilators like albuterol to prevent exercise-induced bronchospasm. Budesonide is a maintenance medication and is not intended for pre-exercise use.

"I should use my inhaler when I have an asthma attack.": Budesonide is not a rescue inhaler and should not be used during an acute asthma attack. Quick-relief inhalers like albuterol are used for immediate symptom management during asthma exacerbations.

"I have nosebleeds once per week.": Occasional nosebleeds are relatively common during pregnancy due to hormonal changes causing increased vascularity and congestion of the nasal passages. While the frequency should be noted, it's generally not a priority to report unless they are severe, frequent, or difficult to control.

"My heart feels like it skips a beat.": Palpitations can occur during pregnancy because of increased blood volume and changes in cardiovascular function. Occasional palpitations are typically benign but should be further evaluated if they become persistent or are associated with other symptoms like chest pain.

"The palms of my hands are red and blotchy.": Red, blotchy palms, known as palmar erythema, are a common and harmless finding during pregnancy due to increased estrogen levels. It does not usually indicate any serious condition and does not require urgent reporting.

Contact the provider within 48 hr to obtain a prescription for the restraints: A provider’s order for restraints must be obtained immediately or within a very short time frame, usually within 1 hour, depending on facility policy. Waiting 48 hours would be inappropriate and could lead to violation of patient rights.

Check that one finger will fit between the client's wrists and the restraints: The correct practice is to ensure that two fingers can fit between the restraint and the skin to prevent circulatory impairment and skin breakdown. One finger would be too tight and could increase the risk of injury.

Fasten the restraints' ties to the bed's side rails: Restraints should always be tied to the bed frame, not the side rails. Attaching restraints to movable parts like side rails can cause injury if the rail is lowered or repositioned, leading to unnecessary strain or trauma to the client.