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Difficulty: MediumEthical Practice

A nurse is caring for a client with advanced heart failure who is participating in a clinical research trial. During the morning assessment, the client states, 'I want to stop taking this experimental drug because the nausea is unbearable, but I am afraid my doctor will be angry and refuse to treat my heart condition.' Which of the following actions should the nurse take to demonstrate ethical practice? Select all that apply.

  1. Validate the client's right to withdraw from the research study at any time without penaltyAnswer
  2. B
    Reassure the client that the provider will not be angry about their decision
  3. Withhold the experimental medication and notify the healthcare providerAnswer
  4. D
    Advise the client to continue the trial for one more week to see if the nausea resolves
  5. Document the client's concerns and the refusal of the medication in the medical recordAnswer
  6. F
    Prioritize administering the scheduled trial medication before contacting the research coordinator

Answer

The correct actions are to validate the client's right to withdraw from the study, withhold the experimental medication and notify the provider, and document the client's concerns and refusal.
The nurse acts as a client advocate by upholding the ethical principle of autonomy. When a client expresses a desire to withdraw from a research trial or refuse medication, the ethical nursing actions include validating their right to do so without fear of penalty, withholding the refused treatment, notifying the appropriate healthcare providers, and thoroughly documenting the interaction.

Step-by-Step Solution

1
Identify the primary ethical principles involved in the client's statement.
The scenario highlights autonomy (the right to self-determination) and nursing advocacy.
Understanding the underlying ethical conflict is necessary to select appropriate nursing interventions.
2
Evaluate each option against the principles of ethical nursing practice and therapeutic communication.
Options supporting self-determination and safety are correct, while those involving false reassurance, personal advice, or overriding the client's refusal are incorrect.
Nursing actions must align with the ANA Code of Ethics and legal boundaries for informed consent.
3
Select all interventions that legally and ethically support the client.
Validating the right to withdraw, withholding the refused drug, notifying the provider, and documenting the event are the correct actions.
These actions directly uphold the client's rights without imposing the nurse's values.

Key Concept

Ethical Practice: Client Autonomy and Advocacy in Clinical Research
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Ethical Practice

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