A charge nurse making rounds observes that assistive personnel has applied wrist restraints to a client who is agitated and does not have a prescription for restraints. Which of the following actions should the nurse take first?

a. Including the time the medication error occurred is important for accurately documenting the sequence of events and providing context for further investigation or review.
b. Making a copy of the incident report for personal record-keeping may not be necessary as the incident report is typically filed in the institution's records system.
c. Identifying the medication name and dosage administered to the client is essential for understanding the nature and severity of the medication error and guiding subsequent actions or interventions.
d. Placing a copy of the completed report in the client's medical record, which is inappropriate because incident reports are internal documents and not part of the client's health record.
e. Obtaining an order from the client's provider to complete the report may not be necessary as incident reporting is typically a standard practice and does not require provider authorization.

1. 1. A. Asking the client's son to go to the waiting area is the appropriate first step if elder abuse is suspected. It allows the nurse to speak with the client privately, which can help the client feel more secure and be more open about discussing sensitive issues such as abuse without fear of retaliation or immediate consequences.
      
      B. Filing an incident report is an important step in documenting suspected abuse, but it should not be the first action taken. Documentation should occur after an initial assessment and gathering of information that supports the suspicion of abuse.
      
      C. Treating and discharging the client may address the immediate physical health needs but does not address the potential safety concerns or the suspicion of abuse. Discharging the client back into a potentially harmful environment without further assessment or intervention could place the client at risk of further harm.
      
      D. Asking the client about his injuries with the son present is not advisable if abuse is suspected. The presence of the potential abuser can influence the client's responses and may prevent the client from disclosing abuse due to fear or intimidation.