A nurse is using incident reports with a group of newly licensed nurses. The nurse should include in the discussion that which of the following situations requires completion of an incident report?

A nurse finds medication on the client’s bedside table upon entering the room.

A client's MAR indicates the 0800 dose of furosemide 20 mg was administered at 0500

A client's medication record MARI indicates the 0800 dose of morphine was withheld because the client refused to take the medication

A nurse finds a secondary infusion bag of an antibiotic that finished infusing 1 hr ago hanging at the clients bedside

Answer and Explanation

The Correct Answer is B

Rationale:

A. A nurse finds medication on the client’s bedside table upon entering the room: While this is a safety concern, it may not necessarily require an incident report unless it resulted in harm or was due to a medication error. It should be documented and investigated, but may not meet the threshold for a formal report depending on facility policy.

B. A client's MAR indicates the 0800 dose of furosemide 20 mg was administered at 0500: This represents a medication administration error—giving the drug significantly earlier than prescribed. Administering time-sensitive medications outside the scheduled time can affect patient safety and should be reported using an incident report for evaluation and prevention.

C. A client's MAR indicates the 0800 dose of morphine was withheld because the client refused to take the medication: Client refusal of medication is not an error and does not require an incident report. It should be documented in the medical record along with any related assessments or follow-up, but it is not a reportable incident.

D. A nurse finds a secondary infusion bag of an antibiotic that finished infusing 1 hr ago hanging at the client’s bedside: This situation suggests a delay in removing the IV bag, which is a minor deviation from ideal practice but typically does not require an incident report unless there was harm, contamination, or risk of adverse outcome.

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Free Nursing Study Resources

Correct Answer is B

Explanation

Rationale:

A. This image shows a newborn with normal skin tone and no visible skin lesions. There are no signs of erythema, pustules, or macules that would suggest erythema toxicum.

B. This image displays multiple small, erythematous macules and papules, especially on the face. These are classic signs of erythema toxicum neonatorum, a common and harmless rash seen in the first days of life.

C. The newborn in this image has generally red skin, which could be due to normal newborn circulation changes or mild erythema, but it lacks the distinctive papular or pustular rash pattern seen in erythema toxicum.

A. Social worker B. Speech therapist C. Physical therapist D. Dentist

Correct Answer is B

Explanation

Rationale:

A. Social worker: A social worker assists with discharge planning, community resources, and emotional or financial support, but does not assess or manage swallowing difficulties.

B. Speech therapist: A speech therapist specializes in evaluating and treating swallowing disorders (dysphagia), especially after neurological events like a stroke. They play a crucial role in preventing aspiration and developing a safe feeding plan.

C. Physical therapist: A physical therapist focuses on mobility, strength, and ambulation training after injury or stroke. While vital for overall recovery, they are not involved in assessing or treating swallowing function.

D. Dentist: Dentists manage oral health, dental structures, and hygiene but are not involved in evaluating or treating swallowing difficulties related to stroke.

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A nurse is using incident reports with a group of newly licensed nurses. The nurse should include in the discussion that which of the following situations requires completion of an incident report?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a newborn who was born 24 hr ago. Which of the following images should the nurse identify as an indication that the newborn has erythema toxicum?

Correct Answer is B

Explanation

A nurse is assisting in the care of a client who had a stroke and is having difficulty swallowing. The nurse should recommend a referral to which of the following members of the interprofessional team?

Correct Answer is B

Explanation

A nurse is contributing to the plan of care for a client who has a gambling disorder. Which of the following nursing interventions should the nurse include in the plan of care?

A nurse is assisting with the care of a client who has experienced a divorce. Which of the following priority actions should the nurse take to promote secondary prevention?

A nurse is using incident reports with a group of newly licensed nurses. The nurse should include in the discussion that which of the following situations requires completion of an incident report?

A nurse is caring for a client who has an injury related to partner violence. The client does not want to report the incident to the authorities or leave their home. Which of the following actions should the nurse take first?

A nurse is monitoring a client's lower extremity following the placement of a cast earlier in the day. Which of the following findings should the nurse identify as manifestations of compartment syndrome? (Select all that apply.)

A nurse is assisting with the care of a client and asks the client. "Can you tell me about your day so far?" Which of the following therapeutic techniques is the nurse using?

A nurse at a local health department is reviewing data from the medical records of a group of clients. Which of the following conditions requires reporting by the nurse?

A nurse is reinforcing teaching about advance directives with a client. Which of the following client statements indicates an understanding of the teaching?