A nurse is assisting with the care of a client.

Exhibits

The nurse is reinforcing teaching for the client and their family about potential adverse effects of the client's prescribed medications.

For each potential adverse effect, click to specify if the effect is. consistent with agranulocytosis, neuroleptic malignant syndrome, or. serotonin syndrome.

Each finding may support more than 1 disease process.

The correct answers are Choices B, C, D, and E.

Choice A rationale: Refusal of meals, especially in an infected client, is not typically incident reportable. Nurses should note this in the client record and monitor the client's nutritional intake and overall condition.

Choice B rationale: Falls are always reportable incidents. When a client falls, an incident report is required to document the event, analyze contributing factors, and implement measures to prevent future falls.

Choice C rationale: Recording an approximate urine output due to leakage from the catheter bag is a reportable incident. Accurate measurement of urine output is essential, and an incident report helps to address the cause of leakage and prevent recurrence.

Choice D rationale: Administering antibiotics before blood culture and sensitivity testing can affect test results and is a reportable incident. The incident report documents the error and helps to implement measures to prevent such occurrences in the future.

Choice E rationale: Administering medication at the wrong time is a medication administration error. An incident report should be filed to document the deviation from the prescribed schedule and address any potential impacts on the client's condition.

Choice A rationale:

Wave hands to attract the attention of law enforcement. Rationale: This is not recommended during an active shooter situation. Waving hands to attract attention may draw the shooter's focus towards you. It's generally safer to stay quiet and hidden rather than trying to signal law enforcement.

Choice B rationale:

Move wounded clients to a safe area before finding shelter. Rationale: While it's important to provide assistance to wounded clients, moving them during an active shooter situation may not be advisable. It can put both the wounded and those attempting to help them at risk. The priority is to find a safe place and take cover while awaiting law enforcement.

Choice C rationale:

Turn cellular phones to silent mode. Rationale: This is the correct action to take. Turning cellular phones to silent mode helps maintain silence and prevent the phone from ringing or vibrating, potentially alerting the shooter to your location. It's essential to maintain silence and avoid drawing attention during an active shooter situation.

Choice D rationale:

Attempt to bargain with the shooter. Rationale: Attempting to bargain with the shooter is not a recommended action. Engaging with the shooter can escalate the situation and put lives at risk. The best course of action is to hide, stay quiet, and await law enforcement intervention.