註冊護理師的哪項行動最明確違反了「不傷害（Nonmaleficence）」的倫理原則？
Which action by the registered nurse most clearly demonstrates a violation of the ethical principle of nonmaleficence?
- ARefusing to administer a lethal dose of intravenous potassium chloride that was secretly requested by the family but not prescribed.拒絕執行家屬秘密要求但未開立處方的致死性靜脈注射氯化鉀。
- BApplying four-point restraints to a profoundly delirious client to prevent the client from pulling out their endotracheal tube.對嚴重譫妄的病人使用四點約束，以防止病人拔出氣管內管。
- CAdministering oral morphine accurately to a terminally ill client, knowing it may mildly depress the client's baseline respiratory drive.準確給予末期病人口服嗎啡，明知這可能會輕微抑制病人的基礎呼吸驅力。
- DSilencing the client's bed alarm so the nurse can catch up on electronic charting without interruption.✓ 正解為免被打擾以便趕完電子病歷，關閉病人的床邊警報。
本題測驗不傷害原則 (Nonmaleficence) 的違規界線。『不傷害 (Nonmaleficence)』的核心精髓是「護士必須主動避免對病患造成可以預防的傷害」。選項 D 護理師為了一己之私 (寫紀錄)，強制關掉病患的離床警報器 (Bed alarm)，這是一項充滿惡意且嚴重瀆職的行為。這直接把高跌倒風險病患暴露於無防備的墜床致死風險中，完美構成了『惡意傷害 (maleficence/negligence)』。選項 C 為了減輕末期病人的疼痛而給嗎啡，即使有微弱的呼吸抑制副作用，這在倫理上稱作『雙重效應原則 (Principle of Double Effect)』，只要主觀意圖是善良的(止痛)，就不違法。選項 A 拒絕家屬非法安樂死 (高鉀致死) 是在遵守不傷害原則。選項 B 為了防止病患拔除維持生命的氣管內管而實施嚴格約束，這符合了保護生命最高利益原則。
Silencing a client's bed alarm for personal convenience violates the ethical principle of nonmaleficence by exposing a vulnerable client to unnecessary risk of harm. Unlike administering morphine for pain relief (double effect) or using restraints for safety, this action prioritizes the nurse's needs over patient safety, constituting negligence.
倫理學的 Double effect (雙重效應)。只要你是為了善意(止痛)，即使藥物有惡意(呼吸變慢抑制)，在法律上是容許的。但關閉警報器是絕對不可饒恕的疏失。