A newly licensed nurse realizes that she administered metoprolol 25 mg PO to the wrong client. Which of the following actions should the nurse perform first?
Measure the client's vital signs.
Complete an incident report.
Inform the nurse manager.
Call the provider.
The Correct Answer is A
Choice A reason: Measuring the client's vital signs is the first action that the nurse should perform, as it helps to assess the client's condition and the possible effects of the medication error. The nurse should monitor the client's blood pressure, heart rate, and respiratory rate closely and report any changes or abnormalities to the provider.
Choice B reason: Completing an incident report is not the first action that the nurse should perform, as it does not address the client's immediate needs or safety. The nurse should complete an incident report after providing care to the client and documenting the medication error in the client's record. The incident report should include the facts of the error, the actions taken, and the outcome of the client.
Choice C reason: Informing the nurse manager is not the first action that the nurse should perform, as it does not provide any intervention or treatment for the client. The nurse should inform the nurse manager after measuring the client's vital signs and calling the provider. The nurse manager can offer support and guidance to the nurse and help with the follow-up actions.
Choice D reason: Calling the provider is not the first action that the nurse should perform, as it does not give the nurse any information about the client's status or the severity of the error. The nurse should call the provider after measuring the client's vital signs and reporting the findings. The provider can order any necessary tests or treatments for the client.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: This is not the correct choice because requesting orientation to the medical-surgical unit is not the first action the nurse should take. Orientation is a process that takes time and planning, and it may not be feasible or necessary for a temporary assignment. The nurse should first ensure that they are competent to perform the tasks and procedures required on the medical-surgical unit.
Choice B reason: This is not the correct choice because referring to the assigned resource nurse regarding client assignments is not the first action the nurse should take. The resource nurse is a person who can provide guidance and support to the nurse during the shift, but they are not responsible for determining the nurse's competencies or assigning clients. The nurse should first communicate with the charge nurse, who is the leader of the unit and has the authority to assign clients according to the nurse's skills and experience.
Choice C reason: This is not the correct choice because informing the nursing supervisor of the lack of experience on the medical-surgical unit is not the first action the nurse should take. The nursing supervisor is a person who can oversee the staffing and operations of the nursing units, but they are not directly involved in the clinical care of the clients or the education of the staff. The nurse should first consult with the charge nurse, who can assess the nurse's competencies and provide appropriate resources and education.
Choice D reason: This is the correct choice because clarifying competencies with the medical-surgical charge nurse is the first action the nurse should take. The charge nurse is a person who can evaluate the nurse's skills and knowledge, assign clients according to the nurse's level of expertise, and provide orientation and training as needed. The nurse should be honest and proactive in communicating their competencies and learning needs to the charge nurse.
Correct Answer is D
Explanation
Choice A reason: Beneficence is the ethical principle of doing good or acting in the best interest of others. While this is an important principle for nurses to follow, it does not directly apply to the situation of reporting the truth about the incident.
Choice B reason: Nonmaleficence is the ethical principle of avoiding harm or minimizing the risk of harm to others. This principle is relevant to the prevention of falls and the use of gait belts, but it does not address the issue of honesty in documentation.
Choice C reason: Fidelity is the ethical principle of being faithful or loyal to one's commitments and responsibilities. This principle relates to the nurse's duty to provide safe and competent care to the client, but it does not specify the obligation to report the facts accurately.
Choice D reason: Veracity is the ethical principle of telling the truth or being truthful. This principle is the most appropriate for the charge nurse to follow in this case, as it requires the nurse to report the incident honestly and completely, including the omission of the gait belt. This is essential for quality improvement, legal protection, and ethical accountability.
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