A nurse is reviewing a client's medical record and discovers that the client received a double dose of a prescribed medication. Which of the following actions should the nurse take?
Report the incident to the manager of the pharmacy.
Place a copy of the incident report in the client's record.
Document the doubled dose in the client's medical record.
Contact the nurse from the previous shift to report the doubled dose.
The Correct Answer is A
A. Reporting the incident to the manager of the pharmacy is the appropriate action to ensure that the medication error is addressed and investigated properly, as this can help prevent future occurrences.
B. Incident reports should not be placed in the client's medical record, as they are separate documents meant for internal review and quality improvement.
C. Documenting the doubled dose in the client's medical record does not fulfill the legal requirements for reporting medication errors and could mislead future care providers about the medication administration history.
D. Contacting the nurse from the previous shift may be necessary for understanding the situation, but the priority is to report the incident properly to ensure patient safety.
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Correct Answer is A
Explanation
A. Activating the fire alarm is the immediate priority after ensuring the client's safety, as it alerts the entire facility to the potential danger and initiates the fire response protocol.
B. Closing the door to the client's room is important for containing the fire but is secondary to activating the alarm to ensure that emergency services are alerted.
C. Reporting the fire details to the facility emergency extension is necessary but should be done after the alarm has been activated to ensure that help is dispatched quickly.
D. Turning off electrical equipment may not be safe or possible in the event of a fire; the focus should be on evacuation and alerting emergency services.
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.