A college health nurse interprets the peak expiratory flow rate for student who has asthma and finds that the student is in the yellow zone of his asthma action plan. The nurse should base her actions on which of the following information? (Select all that apply.)

A. Develop a quality improvement program for nurses involved in medication administration errors. While quality improvement programs are essential, implementing a targeted program without first analyzing the root causes of errors may not effectively address the underlying issues. A broader review of system-wide factors contributing to medication errors is necessary before designing an intervention.
B. Require staff nurses to demonstrate competency by passing a medication administration examination. Competency assessments may help identify knowledge gaps, but they do not address system-based errors such as workload issues, unclear protocols, or distractions during medication administration. A root cause analysis should be conducted first to ensure that interventions target the actual sources of errors.
C. Provide an inservice on medication administration to all the nurses. Educational sessions can reinforce safe practices, but without identifying the specific factors contributing to errors, they may not be effective. Training should be tailored to address the findings from an initial review of the medication errors.
D. Review the events leading up to each medication administration error. The first step in continuous quality improvement is conducting a thorough analysis of the errors, identifying patterns, and determining root causes. This helps in designing targeted interventions, whether they involve process changes, additional training, or improved safety protocols.

A. Increase the oxygen flow rate. The client is experiencing worsening hypoxia, tachypnea, and dyspnea, indicating progressive respiratory distress due to pulmonary embolism (PE). Increasing the oxygen flow rate is the priority to improve oxygenation, reduce the work of breathing, and prevent further hypoxemia. Providing supplemental oxygen helps stabilize the client while preparing for further interventions. The client’s rapidly deteriorating condition, suggests potential hemodynamic instability. Immediate provider notification ensures urgent evaluation for interventions such as anticoagulation, thrombolytics, or intensive monitoring.
B. Increase the oxygen flow rate, then elevate the head of the bed. While elevating the head of the bed can assist breathing by improving lung expansion, it does not address the underlying pathophysiology of PE. Notifying the provider is more critical, as the client may need immediate pharmacologic or procedural interventions to prevent further deterioration.
C. Administer pain medication, then notify the healthcare provider. Pain relief is important, but in acute respiratory distress, oxygenation and circulatory stability take precedence. Narcotics can depress respiratory drive and worsen hypoxia, making them a lower priority until the client’s respiratory status is stabilized.
D. Encourage deep breathing exercises, then check capillary refill. Deep breathing is beneficial for lung expansion but is not an effective treatment for acute PE. The priority is ensuring oxygenation and immediate medical intervention rather than focusing on routine assessments like capillary refill, which do not directly address the emergency.
E. Elevate the head of the bed, then apply compression stockings. Elevating the head of the bed may help ease breathing, but it is a supportive measure rather than a primary intervention. Compression stockings are used for DVT prevention, not for managing an active embolism, making them inappropriate as a priority action in this scenario.