A nurse is reviewing a client's medical history before administering a new prescription for atropine. Which of the following client conditions is contraindicated?

A) "Reading back the provider's prescription is only necessary for high alert medications": Reading back the provider's prescription is a crucial step in preventing medication errors and should be done for all medications, not just high alert ones. Verbal orders are prone to miscommunication, so repeating the order back to the provider helps ensure accuracy and clarity.

B) "Providers should cosign all verbal prescriptions": This is the correct intervention. Verbal prescriptions are considered high risk for medication errors due to misinterpretation or miscommunication. Having the provider cosign verbal prescriptions adds an extra layer of verification and accountability, reducing the likelihood of errors.

C) "Utilize assistive personnel as a witness to verbal provider prescriptions": While involving another healthcare professional as a witness to verbal prescriptions may provide additional verification, it is not a standard practice and may not be feasible in all situations. Relying solely on assistive personnel for this purpose may not ensure accuracy and could introduce potential communication errors.

D) "Safe abbreviations should only be used by providers": Safe abbreviations should be used by all healthcare team members, not just providers, to prevent medication errors. Standardizing abbreviations reduces the risk of misinterpretation and enhances communication among healthcare providers.

Answer: B. Dispose of the remaining medication while another nurse observes.

Rationale:

A) Return the remaining medication to the facility's pharmacy: Return the remaining medication to the facility's pharmacy: This is not typical practice for partial doses of controlled substances like hydromorphone. The pharmacy usually does not accept leftover portions of such medications.

B) Dispose of the remaining medication while another nurse observes: This is the correct and appropriate action. When administering controlled substances, any unused portion must be properly disposed of to prevent misuse or diversion. Having another nurse observe and document the disposal ensures accountability and adherence to safety protocols.

C) Store the remaining half of the pill in the automated medication dispensing system: Storing a partial tablet of a controlled substance is not appropriate. The automated medication dispensing system is designed to store and dispense whole doses of medication as prescribed. Storing partial tablets can lead to confusion, contamination, and potential misuse. It also increases the risk of medication errors, as the partial dose may not be easily identifiable or accurately accounted for.

D) Place the remaining half of the pill in the unit-dose package: his practice is not acceptable for controlled substances due to the risk of misuse, contamination, and the potential for medication errors. Controlled substances require strict handling and disposal procedures to ensure safety and compliance with regulatory standards. Placing a partial tablet back into the unit-dose package does not align with these standards and could lead to inappropriate use or administration.