The healthcare provider prescribes a 24-hour urine specimen to be collected for creatinine clearance. The client is eager to go home and tells the nurse that the first sample was put in the urinal 2 hours ago. Which action should the nurse implement?
Begin the collection the next day.
Empty the sample into the 24-hour container.
Observe the sample for sediment.
Start collecting the specimen with the next void.
The Correct Answer is D
Choice A rationale
Beginning the collection the next day is not necessary. The 24-hour urine collection can be started immediately with the next void. Delaying the collection may cause unnecessary inconvenience and prolong the client’s hospital stay.
Choice B rationale
Emptying the sample into the 24-hour container is incorrect because the first urine sample should be discarded to ensure that the collection starts with an empty bladder. Including the initial sample would result in inaccurate measurement of creatinine clearance.
Choice C rationale
Observing the sample for sediment is not relevant to the collection process for creatinine clearance. The focus should be on ensuring accurate timing and collection of all urine produced within the 24-hour period.
Choice D rationale
Starting the collection with the next void is the correct action. The 24-hour urine collection should begin with an empty bladder, and the first urine of the day is discarded. The time is noted, and all subsequent urine is collected for the next 24 hours. This ensures accurate measurement of creatinine clearance.
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Correct Answer is D
Explanation
Choice A rationale
Double-checking all dosage calculations is a crucial step in preventing medication errors. This process involves verifying the calculations to ensure the correct dose is administered. However, while important, it is not the most effective technique on its own. It must be combined with other strategies to ensure comprehensive error prevention.
Choice B rationale
Identifying unusually large or small doses is essential in preventing medication errors. This involves recognizing doses that fall outside the typical range for a given medication and patient population. However, this technique alone does not address other potential errors, such as patient misidentification or incorrect medication administration.
Choice C rationale
Comparing the medication label to the order is a fundamental step in preventing medication errors. This process ensures that the correct medication is being administered as per the physician’s order. However, this technique alone does not address other potential errors, such as incorrect dosage calculations or patient misidentification.
Choice D rationale
Using at least two client identifiers before administering a dose is the most effective technique in preventing medication errors. This process ensures that the correct patient is receiving the correct medication. It addresses the critical issue of patient misidentification, which is a common cause of medication errors. By confirming the patient’s identity using two identifiers, such as name and date of birth, the risk of administering medication to the wrong patient is significantly reduced.
Choice E rationale
Involving and educating clients in medication administration is an important strategy in preventing medication errors. Educated clients are more likely to understand their medication regimen and recognize potential errors. However, this technique alone does not address other potential errors, such as incorrect dosage calculations or patient misidentification.
Choice F rationale
Documenting all medication in the electronic record as soon as it is given is a crucial step in preventing medication errors. This process ensures that there is an accurate and up-to-date record of all medications administered. However, this technique alone does not address other potential errors, such as incorrect dosage calculations or patient misidentification.
Correct Answer is B
Explanation
Choice A rationale
Giving the client a hug may not be appropriate in a professional setting and could be perceived as crossing personal boundaries.
Choice B rationale
While touching the client’s forearm, asking “Would you like to talk about it?” is a compassionate and supportive response. It shows empathy and provides the client with an opportunity to express their feelings.
Choice C rationale
Apologizing for disturbing the client and offering to wait until later may not address the client’s immediate emotional needs.
Choice D rationale
Stating that it is a bad time and offering to come back later may not provide the client with the support they need in the moment.