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.為免被打擾以便趕完電子病歷，關閉病人的床邊警報。正確答案
- D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。
- A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。
拒絕執行未經授權的致死性藥物給藥，正是維護不傷害原則的表現。
- B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。
使用必要的約束以防止病人自行拔除氣管內管，是保護氣道的措施，符合行善原則而非傷害。
- C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。
為了末期止痛而給予嗎啡，在倫理學的『雙重效應學說』下是合理的，主觀意圖為緩解症狀而非傷害。
- D · 正確答案為免被打擾以便趕完電子病歷，關閉病人的床邊警報。
為了個人方便而蓄意關閉安全警報，使脆弱病人暴露於可預防的跌倒風險，直接違反不傷害原則。
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。實際要求可能受聯邦法、州法、州護理委員會規則與機構政策影響；本題依題幹所示護理原則作答。
English explanation
Option D is correct because silencing the client's bed alarm merely to finish electronic charting abandons an active safety measure and exposes a client at high risk for falls to preventable injury or a potentially fatal fall. This is negligence and directly violates nonmaleficence, which requires nurses to actively avoid preventable harm. Option A is not selected because refusing an unprescribed lethal dose of intravenous potassium chloride requested secretly by the family upholds nonmaleficence. Option B is not selected because applying four-point restraints to a profoundly delirious client to prevent removal of a life-sustaining endotracheal tube protects the client's life. Option C is not selected because accurately administering oral morphine to relieve a terminally ill client's pain, despite possible mild respiratory depression, follows the principle of double effect when the intended purpose is pain relief and does not violate nonmaleficence.
最近修訂：2026-08-25