A nurse is preparing to administer a measles, mumps, and rubella (MMR) immunization. Which of the following client characteristics is a contraindication to administration?

Rationale:

A. Plan time to complete the task: While the nurse may need to complete the task if it remains undone, doing so without first addressing the AP’s refusal overlooks a potential communication or training issue and does not resolve the underlying problem.

B. Assign the task to another AP: Reassigning the task without understanding the reason for refusal may perpetuate noncompliance and disrupt team dynamics. It is important to first clarify why the AP is unwilling before redirecting the task.

C. Notify the charge nurse immediately: Escalating to the charge nurse is appropriate if the issue cannot be resolved directly. However, the first action should be to attempt communication and resolution with the AP to encourage accountability and collaboration.

D. Discuss the AP's concerns about the task: This is the most appropriate initial response. By opening a discussion, the nurse can identify whether the refusal stems from a misunderstanding, lack of training, or legitimate concern, allowing for timely correction or education.

Rationale:

A. "Controlled substances are kept in the bottom drawer of the medication cart.": Controlled substances are stored in locked, secure medication dispensing systems or locked drawers—not casually in the bottom drawer. Security measures are in place to prevent diversion and ensure accurate tracking.

B. "I should verify the number of controlled substances at the end of the shift. The provider is responsible for inventory of controlled substances.": While end-of-shift counts are standard practice, the nurse not the provider is responsible for verifying inventory at shift change. Accountability for handling and documenting controlled substances lies with nursing staff.

C. "If a controlled substance requires a waste, a second nurse must witness the waste.":
This is a correct and essential safety protocol. When wasting part of a controlled substance dose, a second licensed nurse must witness and document the waste to prevent diversion and ensure accurate medication tracking.

D. "Computer controlled substance inventory is reported to the Drug Enforcement Administration every 10 years.": Facilities are required to maintain records and conduct regular audits, and the DEA mandates inventory at least every 2 years not every 10. Reporting frequency and requirements are more stringent.