The nurse is working with clients with personality disorders that are having problems with relationships and other parts of their life. Which barrier(s) is the nurse experiencing when working with this group of clients? Select all that apply.

Choice A: The narcotic count is incorrect when the nurse ends the shift

An incorrect narcotic count at the end of a shift is a serious issue that could indicate potential drug diversion. It's crucial for nurses to accurately count and document narcotics to ensure patient safety and maintain legal and ethical standards. Therefore, this behavior should be reported to the nurse manager.

Choice B: The nurse has poor hygiene practices and has an offensive body odor

While poor hygiene and offensive body odor can be disruptive and unpleasant in a workplace setting, they are not direct indicators of substance use disorder. However, it's important to note that changes in personal hygiene can sometimes be a sign of other health or personal issues.

Choice C: The observing nurse finds oral narcotics blister packs torn in the back

Finding torn narcotics blister packs could indicate that a nurse is diverting drugs for personal use. This is a serious violation of nursing practice and should be reported immediately.

Choice D: The clients are reporting a lack of pain control when the nurse is working

If patients consistently report a lack of pain control when a specific nurse is working, it could suggest that the nurse is not administering the prescribed pain medications properly¹?¹?¹?¹?¹?. This could be due to a variety of reasons, including potential drug diversion, and should be reported.

Choice E: The nurse administers narcotics and then goes to use the bathroom

Frequent bathroom breaks immediately after administering narcotics could be a red flag for drug diversion. While there could be other explanations, this behavior in the context of the other signs could indicate a substance use disorder and should be reported.

Choice A reason: Given Brian's recent substance use and expression of not being able to tolerate depressive feelings, a suicide risk assessment is the highest priority to ensure his immediate safety.

Choice B reason: While a neurological assessment may be relevant, it is not the highest priority when there is a potential risk of suicide.

Choice C reason: Assessing the amount of current cannabis use is important but secondary to evaluating the risk of suicide.

Choice D reason: Marital status may inform social support but is not the highest priority in the context of potential self-harm.