A nurse is caring for a client who suddenly develops chest pain and dyspnea. Which of the following actions should the nurse take first

A. A client who developed a pressure ulcer on the sacrum: The development of a pressure ulcer during hospitalization is considered a preventable adverse event and requires an incident report. It reflects a potential lapse in standard care practices related to skin integrity and client repositioning.

B. A client who refused to take a prescribed stool softener: Clients have the right to refuse medications. This occurrence should be documented in the medical record, but it does not require an incident report since it is an exercise of client autonomy.

C. A client who reported feeling dizzy while ambulating: Feeling dizzy during ambulation should be documented and addressed with safety measures, but if no fall or injury occurred, it typically does not necessitate a formal incident report.

D. A client who received medication 1 hr after it was due: A slight delay in medication administration may need to be documented depending on the medication's importance, but a 1-hour delay, unless involving critical medication like insulin or anticoagulants, usually does not require a formal incident report.

A. Psychologist: A psychologist focuses on mental health assessment and therapy rather than medication management. While they are essential for emotional and psychological support, they are not trained to evaluate or address potential drug interactions in a client's medication regimen.

B. Advanced practice nurse: An advanced practice nurse, such as a nurse practitioner, has the education and authority to assess medication regimens, recognize potential drug interactions, and make adjustments or recommendations. They are well-qualified to manage complex medication issues and collaborate closely with prescribing providers.

C. Patient care technician: Patient care technicians assist with basic care activities such as hygiene, mobility, and vital signs monitoring but do not have the education or licensure required to evaluate medications. They are not involved in clinical decision-making regarding pharmacologic therapy.

D. Social worker: A social worker provides resources for social support, financial assistance, and counseling, but medication management is outside their scope of practice. They are valuable for holistic care but not for assessing or managing drug interactions specifically.