A nurse is contributing to an in-service for newly licensed nurses about situations requiring an incident report. Which of the following examples should the nurse include?
A nurse observes a client vomiting after receiving an oral pain medication.
A nurse observes another nurse remove wrist restraints one at a time from a client who is currently calm.
A nurse discovers that an electronic IV pump.delivered twice the prescribed amount of fluid to a client.
A nurse discovers that a client's family member has administered a PCA dose.
The Correct Answer is C
This situation involves a medication error that could potentially harm the client, and it should be reported through an incident report.
The following examples may not require an incident report:
A nurse discovers that a client's family member has administered a PCA dose. PCA (Patient-Controlled Analgesia) is a method of pain management that allows the client to self-administer pain medication within predetermined limits. If a family member administers the PCA dose without proper authorization or understanding, it is a safety concern that should be reported.
A nurse observes a client vomiting after receiving an oral pain medication. While this situation should be assessed and managed appropriately, it does not necessarily warrant an incident report unless there are additional factors or complications involved.
A nurse observes another nurse remove wrist restraints one at a time from a client who is currently calm. This situation may raise concerns regarding proper restraint removal techniques or potential safety issues, but it does not inherently indicate an immediate need for an incident report. However, if the nurse's actions were contrary to policy or posed a risk to the client's safety, it should be reported.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
a.Adequate fluid intake is important while taking ciprofloxacin to prevent dehydration, especially if diarrhea occurs.
b. Ciprofloxacin can disrupt the normal balance of bacteria in the gastrointestinal tract, potentially leading to diarrhea. Informing the client about this possible side effect allows them to be prepared and take appropriate measures, such as maintaining hydration and notifying their healthcare provider if diarrhea becomes severe or persistent. However, warning about sunburnis crucial as it addresses a specific side effect (photosensitivity) that clients may not be aware of, and it provides actionable advice to mitigate the risk (use of sunscreen and protective clothing).
c.Ciprofloxacin, like other fluoroquinolone antibiotics, can increase sensitivity to sunlight (photosensitivity). Clients should be advised to use sunscreen, wear protective clothing, and avoid prolonged sun exposure while taking this medication.
d.Ciprofloxacin should not be taken with antacids, calcium supplements, or dairy products because they can interfere with the absorption of the medication. It's best to take ciprofloxacin either 2 hours before or 6 hours after taking antacids or products containing calcium, magnesium, aluminum, iron, or zinc.
Correct Answer is B
No explanation
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