A male client tells the practical nurse (PN) that he usually takes a smaller white tablet, not the large blue tablet that the PN gives him. Which action should the-PN implement first?
Check the medical record to verify the medication's name and strength.
Reassure the client that the blue tablet is the correct medication.
Explain that the tablets are from different manufacturers
Withhold the medication and notify the healthcare provider.
The Correct Answer is A
A. Check the medical record to verify the medication's name and strength: The first action is to verify the medication against the medical record to ensure it is the correct drug, dose, and formulation. This prioritizes patient safety by confirming accuracy before administration, preventing possible medication errors.
B. Reassure the client that the blue tablet is the correct medication: Reassuring the client without verifying the medication could risk administering the wrong drug. Even if the nurse believes the medication is correct, professional standards require verification when a discrepancy is noted by the patient.
C. Explain that the tablets are from different manufacturers: Differences in tablet appearance between manufacturers are common, but assuming this without verifying could result in a serious medication error. Visual differences should always be validated against the order and pharmacy records first.
D. Withhold the medication and notify the healthcare provider: Withholding the medication and notifying the healthcare provider may be appropriate if verification reveals a problem. However, the first step is to check the medical record to determine if the medication given matches the prescribed drug and dose.
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Related Questions
Correct Answer is B
Explanation
A. Standards of practice for practical nursing: While important for general nursing care, national or professional standards do not replace the specific legal requirements outlined by the state’s licensing authority, which directly govern what a PN can and cannot do.
B. The licensing state's PN scope of practice: Each state defines the legal scope of practice for practical nurses, including what tasks they are authorized to perform. Reviewing the specific state's scope of practice ensures the PN practices legally and professionally in the new employment setting.
C. Geriatric standards of care guidelines: Geriatric care guidelines help provide quality care for older adults but are not the first priority when ensuring lawful nursing practice across state lines. Legal requirements must be understood first.
D. The employing agency's procedure manuals: While agency policies are important for specific job performance, they must be aligned with the state's legal scope of practice. Knowing the legal boundaries first is crucial before following any workplace procedures.
Correct Answer is B
Explanation
A. Offer fluids: Offering fluids is not appropriate when the client shows signs of central cyanosis, as it does not address impaired oxygenation and may pose an aspiration risk if the client is hypoxic or has altered mental status.
B. Administer oxygen: Cyanosis of the lips and tongue indicates poor oxygen saturation and tissue hypoxia. Administering oxygen is the priority action to improve oxygen delivery and prevent respiratory compromise.
C. Ask about pain: While assessing pain is important, it is not the priority in the presence of cyanosis, which reflects a potentially life-threatening oxygenation issue requiring immediate intervention.
D. Provide mouth care: Mouth care is not urgent and does not address the underlying problem of hypoxia. It should be deferred until after the client’s oxygenation status is stabilized.
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