A nurse is reviewing a client's medical record and discovers that the client received a double dose of a prescribed medication. Which of the following actions should the nurse take?

Contact the nurse from the previous shift to report the doubled dose.

Document the doubled dose in the client's medical record.

Place a copy of the incident report in the client's record.

Report the incident to the manager of the pharmacy.

Answer and Explanation

The Correct Answer is B

A) Contact the nurse from the previous shift to report the doubled dose:

While it may be appropriate to communicate with the nurse from the previous shift to gather information about the medication administration, contacting them solely to report the doubled dose may not be the most effective action. The priority is to ensure appropriate documentation of the incident and take necessary steps to address it.

B) Document the doubled dose in the client's medical record:

Documenting the doubled dose in the client's medical record is essential for accurate and transparent documentation of the incident. This documentation should include details such as the medication, dosage, time of administration, and any actions taken in response to the error. It ensures that all members of the healthcare team are aware of what occurred and facilitates appropriate follow-up and monitoring.

C) Place a copy of the incident report in the client's record:

While completing an incident report is necessary to formally document the medication error and initiate an investigation, simply placing a copy of the report in the client's record may not be sufficient. The incident report typically serves as an internal document used for quality improvement purposes and may not be part of the client's official medical record.

D) Report the incident to the manager of the pharmacy:

Reporting the incident to the manager of the pharmacy may be appropriate for addressing potential medication dispensing errors or system issues but may not be the immediate action required when a medication error occurs at the administration stage. The first priority is to ensure accurate documentation of the error in the client's medical record.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

A) Informed consent:

While informed consent documents provide information about the proposed surgical procedure, they typically do not include information about organ donation. Informed consent focuses on the risks, benefits, and alternatives of the procedure being performed, as well as the client's agreement to undergo the procedure.

B) Advance directives:

Advance directives, such as a living will or healthcare proxy, can contain information about a client's preferences regarding organ donation. These documents specify the client's wishes regarding medical interventions, including organ donation, in the event that they become incapacitated and unable to make decisions for themselves. Advance directives guide healthcare providers and family members in honoring the client's preferences regarding end-of-life care and organ donation.

C) Do-not-resuscitate order:

A do-not-resuscitate (DNR) order instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. While organ donation preferences may be discussed in the context of end-of-life care decisions, a DNR order specifically pertains to resuscitative measures and does not provide information about organ donation.

D) Provider's prescription:

A provider's prescription typically pertains to specific medications or treatments ordered by the healthcare provider for the client's care. It does not typically contain information about organ donation. Organ donation preferences are typically documented in advance directives or other specific forms related to donation programs.

A. Send the client for the test with the unsigned form. B. Wake the client and ask them to sign the form. C. Obtain consent from a family member. D. Inform the charge nurse.

Correct Answer is D

Explanation

A) Send the client for the test with the unsigned form:

This option is not appropriate because performing an invasive procedure without obtaining informed consent from the client violates ethical and legal principles. Proceeding without proper consent could lead to legal and ethical repercussions, and it is not considered a safe or acceptable practice.

B) Wake the client and ask them to sign the form:

Waking the client who has received a sedative to obtain their signature on the consent form is not advisable. The client may still be under the influence of the sedative, which could impair their ability to understand the information provided and make an informed decision. Additionally, obtaining consent in this manner may not be legally valid and could compromise the client's autonomy and rights.

C) Obtain consent from a family member:

While obtaining consent from a family member might seem like a reasonable option, it is not appropriate in this scenario without clear documentation of the client's inability to provide consent. Consent for medical procedures should ideally be obtained directly from the competent adult client unless they are incapacitated or unable to make decisions. In this case, the client is asleep due to the sedative, but there is no indication that they are incapable of providing consent. Therefore, relying on a family member's consent without attempting to obtain it from the client first may not be ethically or legally justified.

D) Inform the charge nurse:

This is the most appropriate action to take initially. Informing the charge nurse allows for consultation and guidance on how to proceed in this situation. The charge nurse may advise on the appropriate steps to follow, such as contacting the provider or waiting for the client to regain consciousness to obtain informed consent. It ensures that the situation is addressed promptly and in accordance with institutional policies and ethical standards.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is reviewing a client's medical record and discovers that the client received a double dose of a prescribed medication. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is scheduled for surgery. While reviewing the client's medical record, the nurse notes the client is an organ donor. Which of the following documents provides information about organ donation?

Correct Answer is B

Explanation

A nurse is caring for a client who has a prescription for an invasive procedure that requires consent. When the nurse arrives at the bedside to obtain the client's signature they find that the client is asleep after receiving a sedative. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

A nurse is reinforcing teaching about torts with a newly licensed nurse. The nurse should include which of the following as an example of negligence?

A nurse is delegating care to assistive personnel. Which of the following assignments should the nurse make?

A nurse in a long-term care facility is reinforcing teaching with a newly licensed nurse about chemotherapy-induced nausea. Which of the following food selections indicates the newly licensed nurse understands the teaching?

A nurse is assisting with the care of a client who is experiencing a cardiac arrest. Which of the following tasks should the nurse assign to an assistive personnel?

A nurse is assisting with the discharge of a client from acute care to home health care. Which of the following components of the medical record should the nurse provide to the home health agency?

A nurse is attending a quality improvement meeting. Which of the following actions should the nurse take first when initiating a quality improvement program to address health care-associated infections?

A nurse is caring for a 16-year-old client who was in a motor-vehicle crash and needs surgical intervention immediately. The staff cannot reach either of the client's parents. The nurse should identify that which of the following is true about obtaining consent?

A nurse is caring for an older adult client who has advanced dementia and needs a blood transfusion. The client previously designated her adult daughter on a durable power of attorney for health care form, and the daughter refuses the treatment. Which of the following actions should the nurse take?