A nurse discovers that a medication error was made, administering the wrong drug to a patient. Considering the ethical principle of veracity, what is the most appropriate first action the nurse should take?

Rationale:
A. “Prescription received for MSO44.0 mg PRN pain” requires intervention because it is ambiguous and contains unsafe abbreviations and formatting. “MSO4” is commonly used to abbreviate morphine sulfate, but in this entry it is written as “MSO44.0 mg,” which could be misread as 440 mg or another incorrect dose. Such ambiguity increases the risk of a serious medication error, including overdose, which could result in respiratory depression or death. The Institute for Safe Medication Practices (ISMP) and The Joint Commission specifically recommend avoiding dangerous abbreviations like MSO4 and instead spelling out the full drug name (“morphine sulfate”) and writing the dose clearly. Documentation should also include the route, frequency, and purpose when appropriate to ensure clarity for all members of the healthcare team.

B. “Urine collected for UA and C & S” is correct. This entry clearly indicates that a urine specimen was collected for urinalysis (UA) and culture & sensitivity (C&S). It is concise, unambiguous, and provides essential information for laboratory processing and clinical follow-up.

C. “Client assisted OOB, instructed to splint ABD” is correct because it documents both the nursing intervention and patient education. OOB (out of bed) indicates mobility assistance, and “instructed to splint ABD” shows the nurse provided guidance to protect the abdomen postoperatively or post-injury. The entry is clear, clinically relevant, and reflects proper nursing documentation.

D. “12 units of regular insulin administered subcut” is correct because it includes the dose, type of insulin, and route of administration. This meets safe medication documentation standards and ensures clarity for all providers reviewing the record. Additional details such as time and site of administration could further enhance completeness, but the entry is fundamentally safe and accurate.

Rationale:

A. Utility is incorrect because the principle of utility focuses on maximizing overall benefit or the greatest good for the greatest number of people. While utility considers outcomes for many, the nurse’s action here is focused on protecting an individual’s privacy, not on weighing benefits for a group.

B. Justice is incorrect because justice refers to fairness, equity, and impartial treatment in healthcare, including allocation of resources or services. Maintaining the surgeon’s confidentiality is not an issue of equitable distribution or fairness, but rather an ethical responsibility to the individual.

C. Paternalism is incorrect because paternalism involves making decisions for someone else, potentially overriding their autonomy, because you believe it is in their best interest. In this case, the nurse is not making a decision for the surgeon; rather, the nurse is honoring the surgeon’s right to privacy and autonomy regarding personal medical information.

D. Nonmaleficence is correct because nonmaleficence embodies the ethical principle of “do no harm.” By refusing to disclose the surgeon’s medical diagnosis, the nurse is preventing potential harm, which could include professional consequences, discrimination, stigma, or emotional distress. Protecting confidential information is a key way that nurses uphold nonmaleficence, ensuring that their actions do not inflict harm on patients or colleagues.