A nurse is reviewing the purpose of advance directives with a client. Which of the following statements should the nurse make?

Rationale:

A. "Controlled substances are kept in the bottom drawer of the medication cart.": Controlled substances are stored in locked, secure medication dispensing systems or locked drawers—not casually in the bottom drawer. Security measures are in place to prevent diversion and ensure accurate tracking.

B. "I should verify the number of controlled substances at the end of the shift. The provider is responsible for inventory of controlled substances.": While end-of-shift counts are standard practice, the nurse not the provider is responsible for verifying inventory at shift change. Accountability for handling and documenting controlled substances lies with nursing staff.

C. "If a controlled substance requires a waste, a second nurse must witness the waste.":
This is a correct and essential safety protocol. When wasting part of a controlled substance dose, a second licensed nurse must witness and document the waste to prevent diversion and ensure accurate medication tracking.

D. "Computer controlled substance inventory is reported to the Drug Enforcement Administration every 10 years.": Facilities are required to maintain records and conduct regular audits, and the DEA mandates inventory at least every 2 years not every 10. Reporting frequency and requirements are more stringent.

Rationale:

A. Ask the client to describe the incident: The first step is to gather detailed and accurate information about what happened. This not only allows the nurse to assess the severity and risk of harm but also builds trust with the client. Understanding the specifics of the situation is essential before planning further interventions.

B. Assist the client with developing a safety plan: While crucial for long-term well-being, safety planning should come after assessing the current situation. The nurse must first understand the context of the incident to tailor the plan effectively and ensure it aligns with the client’s readiness and safety.

C. Provide the client with information about local shelters: Offering shelter information is supportive and may be part of discharge or follow-up teaching. However, this should follow the initial assessment, as the client may not yet be ready to consider leaving or may have specific needs not met by general resources.

D. Refer the client to a support group: Support groups are helpful for emotional healing and connection but are not an immediate priority. Without understanding the client’s current circumstances, risk level, and readiness to engage, such a referral may not be appropriate at this stage.