A client who is febrile is admitted to the hospital for treatment of pneumonia. In accordance with the care pathway, antibiotic therapy is prescribed. Which of the following situations requires the nurse to complete a variance report with regard to the care pathway?

An allergy to penicillin required an alternative antibiotic to be prescribed.

Antibiotic therapy was initiated 2 hr after implementation of the care pathway.

The route of antibiotic therapy on the care pathway was changed from IV to PO.

A blood culture was obtained after antibiotic therapy had been initiated.

Answer and Explanation

The Correct Answer is D

The correct answer is: d.

Choice A reason: An allergy to penicillin requiring an alternative antibiotic to be prescribed is a common and expected variation in care. Allergies are patient-specific factors that must be accommodated within the care pathway. The need for an alternative antibiotic does not typically constitute a variance that requires reporting, as adjustments for allergies are part of personalized care planning.

Choice B reason: Initiating antibiotic therapy 2 hours after implementation of the care pathway may not require a variance report if it falls within the acceptable time frame for antibiotic administration. The timing of antibiotic therapy can be critical, but slight deviations are often accounted for within the care pathway guidelines. However, if the care pathway specifies a narrower time frame for initiation, then this could be a reportable variance.

Choice C reason: Changing the route of antibiotic therapy from IV to PO (oral) is a clinical decision that may be based on the patient's condition, progress, and ability to tolerate oral medications. This switch is a part of antimicrobial stewardship and is often encouraged when clinically appropriate to reduce IV line use and potential complications. It is a standard practice and does not typically require a variance report unless the change contradicts a specific protocol in the care pathway.

Choice D reason: Obtaining a blood culture after the initiation of antibiotic therapy is a significant variance from the standard care pathway. Blood cultures should be obtained before starting antibiotics to accurately identify the causative organisms and their antibiotic sensitivities. Starting antibiotics before obtaining blood cultures can reduce the likelihood of growing the bacteria in the culture, potentially leading to misdiagnosis and inappropriate treatment. This is a deviation from the standard of care that requires a variance report.

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Correct Answer is C

Explanation

Choice A reason: Obtaining a prescription for a sedative for the client is not a correct action, as it may cause adverse effects such as confusion, falls, or respiratory depression. The nurse should avoid using sedatives unless absolutely necessary and use non-pharmacological interventions to calm the client.

Choice B reason: Removing the clock and calendar from the client's room is not a correct action, as it may worsen the client's disorientation and anxiety. The nurse should provide orientation cues such as a clock, a calendar, a radio, or a newspaper to help the client maintain a sense of time and reality.

Choice C reason: Providing distractions for the client during the day is a correct action, as it may reduce the client's boredom, agitation, and wandering behavior. The nurse should engage the client in meaningful activities such as music, games, crafts, or exercise that suit the client's interests and abilities.

Choice D reason: Raising all four side rails on the client's bed is not a correct action, as it may increase the risk of injury or entrapment if the client tries to climb over them. The nurse should use the least restrictive measures to prevent wandering, such as alarms, locks, or supervision.

A. Recommend the son meet with the provider to get information about his mother's condition. B. Complete an incident report regarding the breach of the client's confidentiality. C. Log out the computer so that the client's son is unable to view his mother's information. D. Report the possible violation of client confidentiality to the nurse manager.

Correct Answer is C

Explanation

Choice A reason: This is not the correct choice because recommending the son meet with the provider to get information about his mother's condition is not the first action the nurse should take. The nurse should first stop the unauthorized access to the client's records and protect the client's privacy and confidentiality. The nurse can then offer to arrange a meeting with the provider if the son has questions or concerns.

Choice B reason: This is not the correct choice because completing an incident report regarding the breach of the client's confidentiality is not the first action the nurse should take. The nurse should first intervene to prevent further disclosure of the client's information and secure the computer. The nurse can then document the incident and follow the facility's policy and procedure for reporting such events.

Choice C reason: This is the correct choice because logging out the computer so that the client's son is unable to view his mother's information is the first action the nurse should take. The nurse should act quickly and assertively to terminate the unauthorized access to the client's records and safeguard the client's rights. The nurse should also explain to the son why his action was inappropriate and how it violated the client's confidentiality.

Choice D reason: This is not the correct choice because reporting the possible violation of client confidentiality to the nurse manager is not the first action the nurse should take. The nurse should first address the immediate situation and ensure that the client's information is no longer accessible to the son. The nurse can then inform the nurse manager and the provider about the incident and the actions taken.

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A client who is febrile is admitted to the hospital for treatment of pneumonia. In accordance with the care pathway, antibiotic therapy is prescribed. Which of the following situations requires the nurse to complete a variance report with regard to the care pathway?

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