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Covering up a medication error prevents timely assessment and intervention, which can place the client at significant risk for harm. Ethical nursing practice requires honesty and accountability to ensure patient safety and quality care. Failure to report also violates professional standards and legal obligations.

Shifting blame to the pharmacy does not address the immediate safety needs of the client or allow for appropriate clinical follow-up. Medication administration is a shared safety process, and the nurse remains responsible for reporting errors regardless of their source. Effective error management focuses on correction, not fault.

Delaying action until the end of the shift increases the risk of adverse outcomes if the client experiences a reaction or complication. Prompt reporting allows for early monitoring, treatment, and prevention of further harm. Timeliness is a key component of safe medication practices.

Inhibits the renin-angiotensin-aldosterone system: Hydralazine does not act on the RAAS pathway and does not block angiotensin-converting enzyme or angiotensin receptors. Medications such as ACE inhibitors or ARBs are responsible for this mechanism. Hydralazine works peripherally on vascular smooth muscle.

Promotes sodium and water retention: Sodium and water retention can occur as a compensatory adverse effect rather than a therapeutic action of hydralazine. This response is related to reflex activation of the sympathetic nervous system and RAAS. It does not explain the drug’s blood pressure–lowering effect.

Increases heart rate to improve cardiac output: Reflex tachycardia may occur secondary to vasodilation, but it is not the intended or primary mechanism of action. Increasing heart rate can increase myocardial oxygen demand and is often an undesirable effect. This action does not directly reduce blood pressure.

Have suction equipment at the bedside: Suction equipment is indicated for clients at risk for airway obstruction or aspiration. Clopidogrel does not affect airway patency or secretion management. This action does not address the primary safety concern associated with antiplatelet therapy.

Initiate contact precautions: Contact precautions are used for clients with contagious infections or multidrug-resistant organisms. Clopidogrel does not increase infection transmissibility or require isolation measures. This intervention is unrelated to the medication’s effects.

Administer medication with each meal: Clopidogrel may be administered with or without food, and food intake does not significantly alter absorption. Giving clopidogrel with meals does not prevent bleeding complications. Meal timing is not required for therapeutic effectiveness.

Encourage the patient to take oral contraceptives at the same time every day to improve effectiveness: Taking oral contraceptives at the same time each day improves contraceptive effectiveness and maintains stable hormone levels. However, consistent timing does not address the significant cardiovascular and thromboembolic risk associated with heavy cigarette smoking. Safety considerations take priority over effectiveness teaching in this scenario.

Instruct the patient to monitor for signs of nausea and mood changes as common side effects of oral contraceptives: Nausea and mood changes are common side effects of oral contraceptives but are generally mild and non–life-threatening. Monitoring for these effects does not address the patient’s elevated risk for serious cardiovascular events. Priority nursing actions focus on preventing severe adverse outcomes.

Recommend the patient increase fat intake to reduce the risk of blood clots while taking oral contraceptives: Increasing dietary fat does not reduce the risk of thromboembolism and may worsen cardiovascular risk factors. There is no evidence supporting fat intake as a protective measure against blood clots. This recommendation contradicts evidence-based cardiovascular health guidance.

Force the client to take the medication: Forcing medication violates the client’s right to autonomy and informed consent. Medication administration without consent can constitute assault or battery. The nurse must respect the client’s decision while ensuring appropriate follow-up.

Administer the medication covertly: Administering medication without the client’s knowledge breaches ethical principles and legal standards. Covert administration undermines trust and can cause harm if adverse reactions occur. This practice is only considered in rare, legally sanctioned circumstances.

Ignore the refusal and move on to the next task: Ignoring a medication refusal fails to address potential health consequences and disrupts continuity of care. The healthcare provider must be informed to evaluate the impact on the treatment plan. Proper communication and documentation are required nursing responsibilities.

Ask the client which medication they prefer to take: Asking the client to choose between duplicated medications places a clinical decision beyond the client’s scope. Medication selection and adjustment require prescriber evaluation of indication, dose, and risk for adverse effects. Client input is valuable but cannot replace provider decision-making.

Discontinue one of the medications immediately: Stopping a medication without a prescription exceeds the nurse’s scope of practice. Abrupt discontinuation may cause therapeutic failure or adverse effects, depending on the drug class. Medication changes must be authorized by the prescribing provider.

Continue with the current medications as prescribed: Continuing duplicated medications increases the risk of toxicity, overdose, or compounded adverse effects. Medication reconciliation is intended to identify and resolve discrepancies before harm occurs. Ignoring duplication defeats the purpose of the safety check.

Diarrhea: Diphenhydramine has anticholinergic properties that reduce gastrointestinal motility. Decreased motility is more likely to cause constipation rather than diarrhea. Diarrhea is not a common adverse effect of first-generation antihistamines.

Bradycardia: First-generation antihistamines do not typically slow the heart rate. Anticholinergic effects are more likely to cause mild tachycardia due to vagal inhibition. Bradycardia is not a characteristic effect of diphenhydramine.

Restlessness: Sedation is more common than agitation in adults taking diphenhydramine. Restlessness or paradoxical excitation may occur, particularly in children or older adults, but it is not the most common effect. Drowsiness remains the predominant side effect.

Corticosteroids increase the immune response and enhance inflammation, aggravating symptoms: Corticosteroids inhibit multiple inflammatory pathways rather than stimulating them. Increasing immune activity would worsen mucosal inflammation in inflammatory bowel disease. This mechanism is opposite to the therapeutic goal of corticosteroid therapy.

Corticosteroids balance electrolytes and water in the body, improving gut motility: Although corticosteroids can affect fluid and electrolyte balance as a side effect, this is not the therapeutic mechanism in inflammatory bowel disease. Symptom relief occurs through anti-inflammatory effects on the intestinal mucosa.

Corticosteroids increase the production of proinflammatory cytokines, improving symptoms in inflammatory bowel disease: Corticosteroids reduce the production of proinflammatory cytokines such as interleukins and tumor necrosis factor. Increasing cytokine production would intensify intestinal inflammation.

Monitor the patient’s respiratory rate: Monitoring respiratory rate is essential for opioid-induced respiratory depression, a serious but separate adverse effect from constipation. While important, it does not directly prevent or manage opioid-induced constipation.

Administer an antiemetic: Antiemetics are used to manage nausea and vomiting associated with opioids but do not affect bowel motility or prevent constipation. Addressing nausea alone will not mitigate the risk of opioid-induced constipation.

Administer a benzodiazepine: Benzodiazepines have sedative and anxiolytic effects but do not influence gastrointestinal motility. They are not indicated for preventing or treating opioid-induced constipation.

Morphine: Morphine is an opioid analgesic used for severe pain, including unrelieved angina, but it is not indicated for managing nitroglycerin-induced headaches. Using morphine for a headache would be inappropriate and excessive.

Codeine: Codeine is a mild opioid used for pain or cough suppression. It is not recommended for nitroglycerin-induced headaches, as the headache is typically mild and self-limiting. Non-opioid analgesics are preferred.

Metoprolol: Metoprolol is a beta-blocker used to reduce myocardial oxygen demand in angina. It does not relieve nitroglycerin-induced headache and is not indicated for this side effect.