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“Go ahead and take your medicine.” Dismisses the patient’s concern and risks a medication error. The nurse must verify before administering.

“Maybe the doctor ordered a different medication.” Speculative and still unsafe-do not guess; verify.

“I’ll leave the pill here while I check with the doctor.” Never leave medications unattended at the bedside; the patient might take it before verification, defeating the safety check.

Pull the ear straight back: Pulling straight back does not optimally straighten the canal in a toddler and may not provide the best route for drops to the tympanic membrane.

Pull the ear up and back: Up and back is the correct maneuver for older children and adults (generally >3 years), because their canal angle is different. Using up-and-back on a toddler may be uncomfortable and less effective.

Pull the ear straight upward: This does not adequately open the canal for optimal instillation in any age group and may be awkward or harmful.

Administer the medication; the doctor knows best: Nurses are legally and ethically obligated to withhold medications that may harm the patient, even if prescribed by a physician. “The doctor knows best” is not an acceptable rationale when patient safety is at risk.

Ask the supervisor to administer the medication: This shifts responsibility but does not resolve the safety issue; if the patient reacts, liability still exists.

Ask the pharmacist to provide a medication to take the place of Dilaudid: Pharmacists cannot unilaterally change a prescribed medication; changes require a new or revised provider order.

Give Mr. Giles the medication and record it in his chart: This violates safe practice because you did not prepare the medication, so you cannot be sure it is correct.

Tell the nurse manager that you do not have time and ask her to get someone else: This is avoiding responsibility without citing the correct safety rationale; time constraints are not the core issue.

Give the medication to Mr. Giles but have the nurse manager chart it: This is unsafe and dishonest; you are still the one administering, so you assume responsibility, even if another charts it.

Record the error on the medication sheet: This is documentation, which is important but not the first step. The patient’s condition must be assessed first.

Notify the physician regarding course of action: The provider should be informed promptly, but only after checking the patient’s condition to provide accurate information about possible harm.

Complete an incident report, explaining how the mistake was made: The report is important for quality improvement but should be done after ensuring patient safety and notifying the provider.