Which ethical principle is illustrated by a nurse who withholds pain medication from a confused client?

The principle illustrated by a nurse who withholds pain medication from a confused client is nonmaleficence. This ethical principle is centered around the obligation to avoid causing harm to patients. In this scenario, the nurse may be concerned that administering pain medication to a confused client could lead to potential harm, such as worsening confusion, sedation, or adverse reactions due to the client's inability to provide informed consent or to communicate effectively.

The essence of nonmaleficence involves gauging the risks and benefits of a treatment or intervention. The nurse's action reflects a commitment to protecting the client from potential harm, even if that means withholding a medication that is typically used to relieve suffering. This demonstrates a careful consideration of the client's current cognitive state and the possible repercussions of administering medication in such a context.

In contrast, concepts like autonomy, beneficence, and justice emphasize patients' rights, overall well-being, and fairness, but do not specifically address the imperative of avoiding harm, which is at the heart of nonmaleficence in this situation.