A patient arrives at the clinic reporting a new onset of angina pectoris that has persisted for the last 30 minutes. What should be the nurse’s initial action?

Choice A rationale
The dosage of Methadone 40.0 mg orally twice a day does not seem unusually low. Methadone is a potent opioid medication used for pain management and the treatment of opioid dependence. Its dosage should be individualized based on the patient’s condition and response to treatment16.
Choice B rationale
The abbreviation “BID” is not listed as a “Do not use” abbreviation. It is a commonly used medical abbreviation that stands for “bis in die,” which means “twice a day” in Latin16.
Choice C rationale
Trailing zeros should be avoided when writing medication orders. Writing “40.0 mg” instead of “40 mg” can lead to dosing errors if the decimal point is not seen, potentially resulting in a tenfold overdose16.
Choice D rationale
There is a need to contact the provider to clarify the order due to the potential for dosing errors associated with the use of trailing zeros16.

Choice A rationale
This statement is more about describing the specific situation (the “D” in DESC) rather than expressing the nurse’s concerns (the “E” in DESC). It’s important to note that the DESC tool stands for Describe, Express, State, and Consequences. In this context, the nurse is merely stating what happened, not expressing how it made them feel or the impact it had on them.
Choice B rationale
This statement accurately represents the “E” component of the DESC tool, which stands for "Express your concerns"12. In this scenario, the nurse is expressing their feelings about the physician’s behavior and its impact on them. They’re stating how the physician’s actions made them feel uncomfortable, especially in front of other staff members and the patient. This is a crucial step in the DESC process as it allows the individual to express their feelings and concerns about the situation.
Choice C rationale
This statement is more aligned with the “S” component of the DESC tool, which stands for "State other alternatives"12. Here, the nurse is suggesting a different way for the physician to express their concerns in the future. While this is an important part of the DESC process, it does not represent the “E” component.
Choice D rationale
This statement represents the “C” component of the DESC tool, which stands for "Consequences stated"12. In this context, the nurse is outlining the potential outcomes if they cannot agree on an alternative approach. While this is a crucial step in the DESC process, it does not represent the “E” component.