A nurse is caring for a client who is scheduled for a hysterectomy and has signed the informed consent form. The client tells the nurse she is unsure about having the procedure. Which of the following responses should the nurse make?

Choice A reason: A provider's prescription is not a resource for developing a standard for removal of indwelling urinary catheters. A prescription is a specific order for a particular client, not a general guideline for a group of clients.

Choice B reason: Maslow's hierarchy of needs is not a resource for developing a standard for removal of indwelling urinary catheters. Maslow's hierarchy of needs is a theory of human motivation that ranks the basic needs of individuals from physiological to self-actualization. It does not provide specific information on how to perform nursing interventions.

Choice C reason: Evidence-based practice is a resource for developing a standard for removal of indwelling urinary catheters. Evidence-based practice is the integration of the best available research evidence, clinical expertise, and client preferences and values into clinical decision making. It helps to ensure that the nursing care is effective, safe, and consistent.

Choice D reason: A critical pathway is not a resource for developing a standard for removal of indwelling urinary catheters. A critical pathway is a tool that outlines the expected course of treatment and outcomes for a specific diagnosis or procedure. It does not provide detailed instructions on how to perform nursing interventions.

Choice E reason: A surgical record is not a resource for developing a standard for removal of indwelling urinary catheters. A surgical record is a document that records the details of a surgical procedure, such as the type of surgery, the anesthesia used, the operative findings, and the complications. It does not provide information on the postoperative care of the client.

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.