A nurse is preparing to administer an antibiotic to a client who has pneumonia. After confirming that the client's assigned identification number matches the medication administration record, the nurse should use which of the following as a second identifier?
Home telephone number
Medical diagnosis
Date of admission
Facility room number
The Correct Answer is A
Rationale:
A. Home telephone number: A home telephone number is an acceptable second client identifier under The Joint Commission's guidelines, as it is specific to the individual and can help prevent medication errors when used alongside another unique identifier.
B. Medical diagnosis: A medical diagnosis is not a unique identifier and may be shared by multiple clients in the same facility. It does not provide adequate confirmation of a client's individual identity.
C. Date of admission: Admission dates are not unique and may be the same for several clients. This information is insufficient as a reliable identifier for ensuring safe medication administration.
D. Facility room number: Room numbers can change during hospitalization and are not considered safe identifiers. Clients may be transferred, making room number an unreliable and non-permanent method of identification.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D"]
Explanation
Rationale:
• Past medical history like Parkinson’s disease increases the risk of delirium but is not a direct symptom. It may contribute but does not confirm the presence of delirium alone. Current behavior and cognition changes are more reliable indicators.
• Illusions involve misinterpreting real stimuli, unlike this client’s perception of spiders that aren’t there. Hallucinations are a more accurate description of this experience. Therefore, illusions are less consistent with the actual findings.
• Change in orientation is a hallmark of delirium and is shown by the client’s confusion about the date and location. The sudden onset and fluctuation in awareness suggest an acute cognitive disturbance. This finding supports the development of delirium in the ICU setting.
• Hallucinations, such as seeing spiders that are not present, reflect sensory misperceptions. These are typical in hyperactive delirium and often cause agitation or fear. They indicate an altered mental state requiring urgent assessment.
Correct Answer is D
Explanation
Rationale:
A. "We only have to tell your parents if your test comes back positive.": Giving conditional privacy based on test results is misleading. Confidentiality in STI testing applies regardless of the outcome and is protected by law in many regions for adolescents.
B. "We need your parents' permission if you are on their insurance.": Insurance coverage does not determine the legal right to consent. While explanation of benefits forms may create confidentiality challenges, consent laws usually allow minors to access STI testing independently.
C. "We will have to get your parents' consent before testing you for STIs.": Requiring parental consent for STI testing contradicts legal protections in many areas that allow minors to access sexual and reproductive health care without parental involvement.
D. “We can test you for STIs without informing your parents.": Supporting the adolescent's autonomy and legal rights, this answer provides accurate information about confidential care and encourages open, respectful communication between the nurse and client.
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