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?
Report the concern to the charge nurse.
Question the nurse who worked the shifts in question.
Notify the pharmacy that the medication was not given.
Document the client's claim in the nurses' notes.
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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Correct Answer is D
Explanation
A. Selecting an intervention is a subsequent step and should be informed by the baseline data on infection rates.
B. Incorporating the change into daily practice is necessary later in the process, once a specific intervention has been chosen and planned.
C. Determining if the change has lowered the infection rate is part of the evaluation phase, following the implementation of interventions.
D. Identifying current infection rates provides baseline data, which is essential for measuring the effectiveness of future interventions. Without this data, it is impossible to determine whether any implemented changes result in improvement.
Correct Answer is D
Explanation
A. Setting specific times for low-priority tasks may not be the most efficient use of time, as client needs can change throughout the shift.
B. Performing complicated tasks independently may not be safe, as it is essential to collaborate with other healthcare team members when necessary for patient safety.
C. Postponing checking for new prescriptions until medications are due could lead to delays in care and negatively impact client outcomes; it's important to check for updates promptly.
D. Clustering care activities for each client promotes efficiency, minimizes interruptions, and helps ensure that all care needs are met in a timely manner.