A fire is reported in the kitchen on the first floor of a three-floor community hospital, and the operator notifies the charge nurse on the third floor to start evacuation procedures. Which intervention should the charge nurse
implement?

Choice A Reason: Remaining with this client and monitoring the vital signs while the nurse takes the call is not an appropriate instruction for the unit clerk. The unit clerk is not qualified to monitor vital signs or provide direct care to clients. The nurse should delegate this task to another licensed nurse or UAP who has been trained and validated in this skill.

Choice B Reason: Asking the healthcare provider to remain on "hold" until the nurse can confirm the prescription is not an appropriate instruction for the unit clerk. The unit clerk is not authorized to take verbal or telephone orders from healthcare providers. Only licensed nurses or pharmacists can do so, following specific policies and procedures.

Choice C Reason: Writing down what is prescribed and then repeating it back to the healthcare provider is not an appropriate instruction for the unit clerk. The unit clerk is not authorized to take verbal or telephone orders from healthcare providers. Only licensed nurses or pharmacists can do so, following specific policies and procedures.

Choice D Reason: Telling the healthcare provider the nurse will return the phone call as soon as possible is an appropriate instruction for the unit clerk. The unit clerk can relay messages between the healthcare provider and the nurse, but cannot take orders or give information about clients. The nurse should prioritize calling back the healthcare provider after stabilizing the unstable client.

Choice A Reason: This is not the first priority because it does not address the client's safety and well-being. The charge nurse should inform the pharmacist who dispensed the medication, but this can be done later.

Choice B Reason: This is the best action because it protects the client from harm and prevents further complications. The charge nurse should evaluate the client for symptoms of a drug overdose, such as nausea, vomiting, drowsiness, or respiratory depression, and administer antidotes or supportive measures if needed.

Choice C Reason: This is not the first priority because it does not provide immediate care to the client. The charge nurse should report the medication error to the nursing supervisor, but this can be done later.

Choice D Reason: This is not the first priority because it does not correct the mistake or prevent recurrence. The charge nurse should review the medication transcription with the nurse, but this can be done later.