A mother called the pediatrician's office, reporting that her infant son had a temperature of 102.6

F. The nurse is to record the information as a Celsius temperature.

What should the nurse write down as the temperature reported by the mother?

Choice A rationale

Documenting the error and notifying the supervisor are necessary steps, but they are not the most immediate or comprehensive actions. The priority in a medication error is patient safety, which requires immediate medical assessment and intervention. This step follows after direct patient care and notification of the physician.

Choice B rationale

Administering the original drug and observing for adverse reactions addresses part of the problem, but it does not prioritize immediate medical consultation regarding the mistakenly administered drug. The focus should be on the potential effects of the incorrect medication and timely intervention to mitigate harm.

Choice C rationale

The most appropriate and immediate action is to call the physician to inform them of the medication error. This allows the physician to assess the potential harm to the patient based on the specific drug, dosage, and patient's condition, and to order appropriate interventions. An incident report is crucial for organizational learning and quality improvement.

Choice D rationale

Deciding not to act based on a quick check of allergies or contraindications is highly negligent and unsafe. Even if there are no apparent immediate contraindications, any medication error carries inherent risks and requires a thorough medical evaluation by the physician. This approach prioritizes patient safety over documentation and investigation.

Choice A rationale

Facilitation is a verbal technique that encourages the patient to say more by using non-verbal cues, such as nodding, or minimal verbal cues like "Mm-hmm" or "Go on.”. While it promotes communication, the statement "Tell me more about that" is a direct prompt for detailed information, not a subtle encouragement.

Choice B rationale

A direct ask is a specific question that elicits a concise, often one-word or brief, answer, such as "Are you in pain?" or "When did the shortness of breath start?" The nurse's statement, however, invites elaboration and detailed description, going beyond a simple direct response.

Choice C rationale

An open-ended ask is a type of question that encourages a comprehensive and descriptive response from the patient, rather than a simple yes or no answer. By asking "Tell me more about that," the nurse invites the patient to elaborate on their experience of shortness of breath, providing a richer understanding of the symptom.

Choice D rationale

Reflection involves repeating a patient's words or phrases to encourage further expression of their feelings or thoughts. While the nurse acknowledges the patient's mention of "shortness of breath," the statement "Tell me more about that" is an invitation for elaboration, not a direct reflection of the patient's exact words to encourage emotional exploration.