A nurse identifies that a client has received a double dose of a medication in error. Which of the following actions should the nurse take first?
Complete an incident report about the occurrence.
Check the client's vital signs.
Notify the charge nurse of the error.
Document the facts of the incident in the nurse's notes.
The Correct Answer is B
A. Completing an incident report is an important step to document the error, but the immediate priority is to assess the client's condition and address any potential adverse effects. Incident reporting can follow once the immediate assessment and interventions are completed.
B. Checking the client's vital signs is the first action to take. The nurse needs to assess the client's physiological response to the double dose, as some medications can have significant effects on vital signs. Monitoring vital signs provides crucial information to determine the client's stability and whether additional interventions are needed.
C. Notifying the charge nurse of the error is an important step, but checking the client's vital signs takes precedence to ensure the client's immediate safety. The charge nurse can be informed after the initial assessment.
D. Documenting the facts of the incident in the nurse's notes is important, but it comes after assessing the client and taking immediate actions to address any potential harm. Documenting the incident helps maintain a comprehensive record and contributes to the overall understanding of the event.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. The statement "Libel is the intentional infliction of emotional distress due to negligent nursing actions" is incorrect. Libel refers to written or published false statements that damage a person's reputation. It is not related to intentional infliction of emotional distress or negligence in nursing actions. This statement reflects a misunderstanding of the concept of libel.
B. The statement "Documenting negative opinions about a client's personality is considered libel" is also incorrect. Libel involves false statements, and expressing negative opinions, even in documentation, may not necessarily qualify as false unless they are untrue statements. However, negative opinions about a client's personality may be considered unprofessional or inappropriate, but they do not constitute libel.
C. The statement "Failing to complete an incident report following a client injury is an act of libel" is incorrect. Libel is related to false statements, and failing to complete an incident report is a failure in documentation but does not inherently involve making false statements. This statement demonstrates a misunderstanding of what constitutes libel.
D. The statement "A nurse can be charged with libel if she discusses client information in a public area" is correct. Discussing client information in a public area, where unauthorized individuals may overhear and obtain sensitive information, can be a violation of confidentiality. While it may not strictly be libel, it could lead to legal and ethical consequences. This statement reflects an understanding of the importance of maintaining client confidentiality and the potential legal implications of disclosing private information in public areas.
Correct Answer is C
Explanation
Hot tea:
Hot tea may not be well-tolerated by individuals experiencing chemotherapy-induced nausea, as hot or strong-smelling foods and beverages can be triggers. It is generally recommended to choose foods at room temperature.
Soft-serve ice cream:
Soft-serve ice cream may be too cold and could exacerbate nausea or discomfort. Cold foods might not be well-tolerated during or after chemotherapy.
Raisin toast:
This is the correct answer. Raisin toast is a good choice as it is a bland and easily digestible carbohydrate. It can be a suitable option for individuals experiencing nausea, providing some calories without strong odors or flavors.
String cheese:
While cheese can be a good source of protein, string cheese might not be the best choice if the individual is experiencing nausea, as the smell or taste of certain cheeses can be strong and trigger nausea.
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