A nurse finds that a client did not receive a scheduled dose of furosemide (Lasix). Which of the following should the nurse include in the incident/variance report? (Select all that apply.)
The name of the provider who prescribed the medication
The time the client was to receive the medication
The date of the Incident
The client's vital signs
The potential adverse effects of the medication
Correct Answer : B,C,D
Rationale:
A. The name of the provider who prescribed the medication is not necessary for the variance report; focus should be on the incident itself.
B. The time the client was to receive the medication should be included to document the discrepancy accurately.
C. The date of the incident is essential for accurate record-keeping and follow-up.
D. The client's vital signs such as blood pressure are especially relevant for medications like furosemide, which affects fluid balance and blood pressure. These values help assess for harm or trends following the missed dose.
E. The potential adverse effects of the medication are not typically included in the incident report but might be noted in the client's ongoing care plan.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Identifying changes within the family unit can be important but is not the immediate priority for medical stabilization.
B. Gaining weight is a critical goal for clients with anorexia nervosa to address their physical health and nutritional status.
C. Making positive statements about body image is helpful but secondary to the goal of weight gain.
D. Feeling in control of behavior is important for long-term recovery but is not the immediate priority compared to physical health.
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"}}
Explanation
Review the incident of disruptive behavior and discuss the principles of civility and respect.
Unit meeting
Rationale: The incident of disruptive behavior between nurses should be addressed in a unit meeting to foster a culture of respect and teamwork. Discussing this issue with the entire team will help reinforce appropriate behavior and conflict resolution.
Review mandatory nursing skills and competencies for nursing.
Unit meeting
Rationale: Mandatory nursing skills competencies are essential for ensuring that all staff meet the required standards. This should be reviewed during the unit meeting to ensure that all nurses are up to date and compliant with required competencies.
Meet to talk about mislabeling of laboratory specimens and discuss the policy and procedure for how to do it correctly.
Individual Team Member
Rationale: The issue of mislabeling specimens should be addressed directly with the specific individual (TJ, the AP) involved. It’s important to provide corrective feedback and retraining for the individual responsible for the issue.
Review near miss fall and fall precautions, bed position, rounding, and appropriate use of bed or chair alarms.
Unit meeting
Rationale: The near-miss fall incident involves issues that are relevant to the entire unit, such as bed position, use of bed alarms, and rounding practices. Discussing this in a unit meeting can help prevent future incidents by educating all staff on proper procedures.
Review central line infections rates and causes. Include review of proper care of central lines.
Unit meeting
Rationale: Reviewing central line infection rates and proper care is important for the entire team to ensure adherence to best practices and reduce infection rates. This is best addressed in a unit meeting to promote awareness and compliance among all staff.
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