A nurse on a medical-surgical unit is caring for a client who asks about advance directives and states that he wants to appoint a health care proxy. Which of the following responses should the nurse make?

a. MS 10 mg IV every 4 prn for pain

This choice is incorrect because it lacks clarity and proper formatting. "MS" could be misunderstood as "morphine sulfate," but it's not specified. Additionally, "every 4 prn for pain" is not a standard way to write a prescription. It should indicate the frequency (e.g., every 4 hours) and the indication for administration (e.g., prn for pain).

b. Morphine sulfate 10 mg IV q 4 hr IV prn for pain

This choice is the correct transcription of the prescription. It clearly states the medication (morphine sulfate), the dosage (10 mg), the route (IV), the frequency (every 4 hours), and the indication for administration (prn for pain).

c. MSO4 10 mg IVP q 4 prn for pain

This choice is incorrect due to the use of abbreviations that may not be universally understood. While "MSO4" likely stands for morphine sulfate, it's preferable to write it out completely to avoid confusion. Additionally, "q 4" is not clear and should be written as "every 4 hours."

d. Morphine sulfate 10.0 mg every 4 hours IV prn for pain

This choice is incorrect because it specifies the dosage with unnecessary precision (10.0 mg instead of 10 mg). While this level of precision is not typically required in medication prescriptions, it doesn't make the prescription incorrect per se. However, it's not the most common or standard way to write medication orders.

a. Review current literature regarding client falls:

This option involves conducting a review of existing research and literature on client falls. Reviewing current literature can provide valuable insights into evidence-based practices and interventions for fall prevention. However, conducting a literature review typically follows problem identification and is part of the process of developing an evidence-based approach to addressing the issue.

b. Implement a fall prevention plan:

Implementing a fall prevention plan involves putting in place strategies and interventions aimed at reducing the risk of falls among clients. While implementing a fall prevention plan is an essential step in addressing the issue, it should be based on a thorough assessment of clients at risk for falls (which comes before planning interventions) to ensure that interventions are targeted and effective.

c. Identify clients who are at risk for falls:

This is the most appropriate first step in the quality improvement process. Identifying clients who are at risk for falls allows healthcare providers to focus interventions on those who are most vulnerable. It involves conducting comprehensive assessments, considering factors such as age, mobility, cognitive status, medications, and history of falls, to determine individual risk levels.

d. Notify staff of the increased fall rate:

While communication with staff about the increased fall rate is important for raising awareness and promoting a culture of safety, it should not be the first action taken in the quality improvement process. Before notifying staff, it's essential to identify clients at risk for falls and develop targeted interventions to address the issue effectively.