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A nurse is caring for a client who reports his medication was not given during the night shift for the past 3 nights. The medication administration record indicates the medication was given. Which of the following actions by the nurse is appropriate?

A.

Report the concern to the charge nurse.

B.

Question the nurse who worked the shifts in question.

C.

Notify the pharmacy that the medication was not given.

D.

Document the client's claim in the nurses' notes.

Answer and Explanation

The Correct Answer is A

A. Reporting the concern to the charge nurse is the appropriate action, as it ensures that the issue is addressed through proper channels. The charge nurse can investigate and determine if further action is needed, such as reviewing the medication administration process.  

 

B. Questioning the nurse directly could lead to confrontations and is not the correct procedure for handling potential discrepancies in medication administration.  

 

C. Notifying the pharmacy is unnecessary at this point because the issue concerns administration rather than medication supply or errors with the prescription.  

 

D. While documenting the client’s report is important, simply documenting the client’s claim without notifying the charge nurse does not fully address the concern.  


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View Related questions

Correct Answer is A

Explanation

A. Obtaining the client's capillary blood glucose level is the first action because it determines the appropriate timing and dosage of insulin administration, ensuring safe and effective diabetes management.

B. Administering prescribed insulin should occur after assessing the client's blood glucose level to avoid the risk of hypoglycemia or hyperglycemia.

C. Providing the client's breakfast is important but should only occur after assessing blood glucose and administering insulin as needed to maintain stable glucose levels.

D. Checking the calibration of the glucometer is essential for accurate readings but does not directly address the immediate need to assess the client's glucose level.

Correct Answer is D

Explanation

A. Contacting the provider for instructions could delay immediate resuscitative efforts, which are required in the absence of a DNR order.

B. Consulting with the client’s family may not be effective in an emergency, as the living will is a legal document, and family members cannot override it without a DNR order.

C. Complying with the living will and letting the client expire naturally would be inappropriate without a formal DNR order in place.

D. Calling a code is the correct action because, legally, resuscitative efforts must be initiated in the absence of a written DNR order from the provider, despite the existence of a living will.

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