A nurse is preparing to administer a medication to a client and discovers that the incorrect dose of medication was administered during the previous shift. Which of the following actions should the nurse take first?
Notify the charge nurse of the error.
Contact the provider.
Check the client for a change in condition.
Complete an incident report.
The Correct Answer is C
A. Notifying the charge nurse is an important action, as it ensures that other team members are aware of the error and can support corrective actions. However, this is not the first action the nurse should take, as assessing the client’s condition takes priority.
B. Informing the provider about the error is essential to allow for any additional orders or corrective measures, such as treatments to mitigate adverse effects. However, the nurse should first assess the client for any changes in condition to report specific findings to the provider if an intervention is needed.
C. Assessing the client’s condition is the first priority when a medication error is discovered. This action helps determine whether the incorrect dose has affected the client, allowing the nurse to provide immediate care if needed.
D. Completing an incident report is necessary to document the error, allowing the facility to review and address any procedural gaps. However, completing the report is not an immediate action in terms of client safety and should occur after assessing the client and notifying the necessary parties.
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Related Questions
Correct Answer is D
Explanation
A. Initiate a 24-hr urine collection for a client who has end-stage kidney disease:
While a 24-hour urine collection is important for assessing kidney function, it is not an urgent task and can be scheduled at a later time without compromising the client's immediate well-being.
B. Change the dressing for a client who has a decubitus ulcer:
Changing the dressing for a decubitus ulcer is important for wound care, but it is not as urgent as addressing respiratory distress in a client with COPD.
C. Administer an antibiotic for a client who has methicillin-resistant Staphylococcus aureus:
Administering an antibiotic for a client with a methicillin-resistant Staphylococcus aureus (MRSA) infection is important, but it is not as immediately critical as ensuring adequate oxygenation in a client with COPD. Respiratory issues take precedence in the hierarchy of priorities.
D. Initiate oxygen therapy via nasal cannula for a client who has COPD.
The priority should be given to tasks that address immediate threats to the client's well-being or safety. In this scenario, initiating oxygen therapy for a client with COPD is a priority because it addresses respiratory distress and hypoxia, which are critical concerns in individuals with COPD. Respiratory interventions take precedence to ensure adequate oxygenation.
Correct Answer is A
Explanation
A. Respect the daughter's decision to refuse the transfusion.Since the daughter has been designated as the durable power of attorney for health care, she has the legal authority to make medical decisions on behalf of her mother. The nurse should respect her decision, even if it involves refusing treatment.
B. Encourage the daughter to let her mother have the transfusion.While the nurse can provide information and support, they should not pressure or coerce the daughter into making a different decision.
C. Discuss taking guardianship of the client with the facility administration.This is unnecessary as the daughter already has the legal authority to make decisions through the durable power of attorney.
D. Ask the provider to give consent for the transfusion.The provider cannot override the decision made by the designated durable power of attorney unless there is evidence that the daughter is not acting in the client's best interest.
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