Near miss:

• Incident Report 1: The nurse identified the client's allergy before administering azithromycin, preventing an adverse reaction. Holding the medication and notifying the provider ensured patient safety, making this a near miss rather than an adverse event.

Adverse Event:

• Incident Report 2: The client did not receive prescribed prophylactic antibiotics during labor, leading to neonatal sepsis. The lack of antibiotic administration increased the risk of serious complications, making this an adverse event with potential long-term consequences.

• Incident Report 3: A tenfold dosing error led to the administration of 60 units instead of 6 units of insulin, resulting in severe hypoglycemia and unresponsiveness. This critical medication error placed the client at significant risk for neurological damage or death, classifying it as an adverse event.

• Incident Report 4: A critically low platelet value was reported but not communicated to the provider, delaying intervention and leading to a coma. The failure to act on critical lab results contributed to a preventable deterioration in the client’s condition, making this an adverse event.

• Incident Report 5: Despite being identified as a fall risk, the client sustained a fall due to a malfunctioning call bell, leading to an injury. The failure to address the defective equipment compromised patient safety, making this an adverse event that could have been prevented.

A. "Your provider will be here later today." Informing the guardian about the provider’s availability does not directly address their request or provide immediate support. While the provider plays a role in discharge planning, the nurse should offer guidance and resources to help the guardian understand the process of taking the child home.

B. "I can give you information on what that would involve." Acknowledging the guardian’s request and offering relevant information demonstrates support and facilitates informed decision-making. Providing education on home care, hospice options, and necessary resources ensures that the guardian is prepared for the transition while maintaining open communication.

C. "I understand how you feel. I felt the same way when my sibling was terminally ill." Sharing personal experiences shifts the focus away from the guardian’s concerns and may not be appropriate in a professional setting. While empathy is essential, the response should remain patient-centered and focused on providing relevant information and support.

D. "I think you should speak with social services about your request." Referring the guardian to social services may be part of the process, but immediately redirecting the conversation does not acknowledge their concerns. The nurse should first provide direct information and reassurance before involving additional support services as needed.

A. "I have a severe allergy to amoxicillin." A severe allergy to amoxicillin suggests a potential cross-reactivity with ceftriaxone, as both belong to the beta-lactam antibiotic class. While cross-reactivity between penicillins and cephalosporins is lower with third-generation cephalosporins like ceftriaxone, a history of severe allergic reactions, such as anaphylaxis, warrants consultation with the provider before administration.

B. "I get sick when I take diuretics." Adverse effects from diuretics do not typically indicate a contraindication to ceftriaxone. While diuretics like furosemide can interact with aminoglycosides to increase nephrotoxicity, ceftriaxone does not share this risk. Monitoring for individual tolerances is important, but this statement does not require holding the medication.

C. "I have a history of hearing problems." Ceftriaxone is not associated with ototoxicity, unlike aminoglycosides or vancomycin. A history of hearing problems does not necessitate withholding the medication, though the nurse should monitor for any new or worsening symptoms if concurrent ototoxic medications are prescribed.

D. "I take prednisone for my asthma." Corticosteroid use does not directly contraindicate ceftriaxone administration. While prolonged corticosteroid therapy may increase the risk of infections or mask symptoms of an allergic reaction, it does not warrant holding the antibiotic. The nurse should continue routine monitoring but can safely proceed with administration.

A. The advice of an expert nephrology nurse. While experienced nurses provide valuable clinical insights, their knowledge may be based on personal experience rather than the latest evidence-based research. Best practices should be supported by scientific studies rather than anecdotal expertise.

B. Retrospective chart reviews. Chart reviews can offer useful data on past interventions and outcomes, but they do not always reflect the most current evidence-based practices. Additionally, they may contain inconsistencies or lack standardized guidelines necessary for broad application.

C. Facility critical pathway. Critical pathways are developed based on evidence-based guidelines, but they may not always reflect the most up-to-date research. These protocols are useful for standardizing care within a specific institution but should be supplemented with current peer-reviewed research to ensure best practices.

D. A recent peer-reviewed nursing research article. Peer-reviewed nursing research articles provide the most current and scientifically validated evidence. These sources undergo rigorous evaluation before publication, ensuring that recommendations are based on high-quality research rather than opinion or outdated protocols.

A. Loud volume of the television set. While a loud television may indicate hearing impairment, it does not pose an immediate safety risk. The nurse should assess the client’s hearing and provide recommendations if needed, but addressing environmental hazards that increase the risk of falls takes priority.

B. Wall-to-wall carpet in the living room. Unlike loose rugs, wall-to-wall carpeting reduces the risk of tripping and slipping. It provides better traction for walking, making it a safer flooring option for older adults compared to hard surfaces or throw rugs.

C. Low chairs without armrests. Low chairs make it difficult for older adults to stand up, increasing the risk of falls. The absence of armrests further reduces stability and support when rising from a seated position. Recommending higher chairs with armrests can enhance mobility and prevent injuries.

D. Use of indirect lighting. Soft, indirect lighting can help reduce glare and improve comfort, but it may not necessarily create safety concerns. However, inadequate lighting in critical areas, such as hallways or staircases, should be assessed to prevent falls.

A. Use surveillance to investigate outbreaks of foodborne illness. Investigating outbreaks falls under the assessment function of public health, which involves monitoring and identifying health problems within the community through data collection and analysis.

B. Monitor the incidence rates of varicella every 2 months. Tracking disease incidence is part of the assessment function, as it involves ongoing surveillance to detect trends and potential public health concerns. This data helps in planning and evaluating interventions but does not directly ensure service delivery.

C. Organize an immunization clinic for at-risk members of the community. Assurance involves ensuring that essential public health services are available and accessible. Organizing an immunization clinic directly provides a critical health service to protect vulnerable populations, making it an example of the assurance function.

D. Educate the community about the health risks of alcohol use. Providing health education aligns with the policy development function, which focuses on informing and empowering the community to make healthier choices through laws, regulations, and initiatives.

A. Report of back pain associated with twisting at the waist. Back pain is a common musculoskeletal issue among agricultural workers due to repetitive movements and heavy lifting. While it requires intervention, it is not immediately life-threatening and does not take priority over acute symptoms that may indicate poisoning or a severe reaction.

B. Absence of a dental health provider. Lack of dental care can contribute to long-term health complications, but it does not pose an immediate risk requiring urgent intervention. Addressing acute medical conditions takes precedence over routine preventive care.

C. Lives in a home with 25 other agricultural workers. Overcrowded living conditions can increase the risk of communicable diseases and poor hygiene-related health issues. However, it is a social determinant of health rather than an urgent clinical concern that requires immediate action.

D. Report of muscle twitching and skin rash. Muscle twitching and skin rash can indicate pesticide poisoning, a common occupational hazard for agricultural workers. Pesticide exposure can lead to serious neurological and systemic effects, making this the priority for immediate assessment and intervention.

A. "Do you spend more time thinking about the past, present, or future?": This question focuses on the client's perspective of time rather than their beliefs about environmental control. While it may provide insight into the client's worldview, it does not directly address how they perceive their ability to influence their health or environment.

B. "Who makes most of the decisions in your family group?": This question may provide some understanding of family dynamics and authority but does not directly assess the client's beliefs regarding their control over their health or environment. It may highlight cultural aspects but lacks a direct connection to environmental control beliefs.

C. "What do you think you can do to affect your health status?": This question directly addresses the client's beliefs about their ability to exert control over their health and environment. It encourages the client to reflect on their agency and the actions they believe they can take to influence their well-being, making it the most relevant choice for assessing environmental control.

D. "Can you list any diseases that your parents or siblings have had?": While understanding the family medical history is important, this question focuses on genetics and familial health rather than the client’s beliefs about their ability to control their environment or health. It does not provide insight into how the client views their role in managing their health.

A. "You can place a client in a chair with a table or tray blocking them as an alternative to restraints.": Using furniture to block a client can restrict their movement and may still be considered a form of restraint. Legal guidelines emphasize the importance of promoting client safety and dignity, so alternative measures should be explored that do not involve restricting movement.

B. "Monitoring the client less often than required can be considered negligence.": Monitoring a client in restraints less frequently than required breaches the duty of care and can lead to harm. Proper monitoring is crucial for the safety and well-being of clients, ensuring that their physical and psychological needs are adequately addressed while they are in restraints.

C. "Family members cannot file a lawsuit when restraints are used for clients who have a mental illness.": Family members retain the right to file lawsuits if they believe that the use of restraints was inappropriate or caused harm, regardless of the client's mental health status. Legal rights apply equally to all clients, including those with mental illness, ensuring accountability in the use of restraints.

D. "Chemical restraints are allowed when there is a high client-to-nurse ratio.": The use of chemical restraints is subject to strict regulations and cannot be justified based solely on staffing levels. These restraints should only be used when necessary for the client's safety and must align with established legal and ethical guidelines, ensuring that they are not used as a solution for managing staffing challenges.

A. "Rub your hands together for at least 10 seconds when washing them.": While handwashing is important for preventing infections, the recommendation for effective handwashing is to rub hands together for at least 20 seconds, not 10. Emphasizing proper handwashing techniques is essential for promoting workplace health.

B. "Keep your abdominal muscles tightened when lifting objects.": While engaging the abdominal muscles can help provide stability during lifting, it is more important to emphasize proper lifting techniques, such as bending at the knees and keeping the load close to the body. This helps prevent injuries and promotes safe lifting practices in the workplace.

C. "Ensure that 20% or less of calories are from saturated fats.": This statement aligns with dietary guidelines aimed at reducing the risk of chronic diseases. Limiting saturated fat intake to 20% or less of total daily calories is important for maintaining heart health and overall well-being. This information is crucial for workers to understand healthy eating habits.

D. "Engage in aerobic exercise 2 to 4 days per week for 20 minutes.": While regular exercise is beneficial, the recommendation for aerobic exercise typically suggests at least 150 minutes of moderate-intensity exercise each week, which translates to about 30 minutes on most days. This statement underrepresents the amount of physical activity needed for optimal health.