A patient has been admitted with a fever of 102.8 F (39.3 C), with an unknown origin.

The patient’s urine is cloudy, foul-smelling, and dark amber.

Orders have been given to obtain urine and blood cultures immediately and to administer an antibiotic intravenously.

In what order should the nurse complete these orders?

Choice A rationale:

Reporting a near-miss using the facility’s recommended protocol and correcting the error on the MAR is the appropriate action. A “near-miss” in healthcare is a situation where an error could have happened, but didn’t, either by chance or timely intervention. It’s crucial to report these incidents as they provide valuable information for risk management and quality improvement. By analyzing near-misses, healthcare facilities can identify potential hazards and take preventive measures to ensure patient safety. Correcting the error on the MAR is also important to prevent the same mistake from happening in the future.

Choice B rationale:

Reporting the near-miss to the next shift before the next dose is due is not the best course of action. While it’s important to communicate any potential issues to the next shift, it’s more crucial to report the incident immediately using the facility’s recommended protocol. This allows for a timely investigation and corrective action. Waiting until the next shift could delay these processes and potentially put patient safety at risk.

Choice C rationale:

Correcting the MAR error but saying nothing because nothing happened is not an appropriate response. Even though the error did not result in any harm, it’s still important to report it. Near-misses are often indicators of underlying system issues that need to be addressed. By not reporting the incident, the opportunity to improve patient safety and prevent future errors is lost.

Choice D rationale:

Notifying the pharmacy about the error they almost caused is not the most appropriate action. While it’s important to communicate with the pharmacy if they were involved in the error, the first step should always be to report the near-miss using the facility’s recommended protocol. This ensures that the incident is properly documented and investigated, and that appropriate corrective actions are taken.

Choice A rationale:

Amphotericin B is a potent antifungal medication used to treat severe fungal infections. However, it is typically reserved for life-threatening systemic fungal infections due to its potential for serious side effects, including kidney damage and infusion reactions. It is not commonly used as a first-line treatment for vaginal yeast infections.

Choice B rationale:

While antifungal creams can be effective for treating vaginal yeast infections, they typically require a treatment course of several days. This option may not be the best choice for a patient seeking a quicker, one-time treatment.

Choice C rationale:

A single dose of a fluconazole oral tablet is often an effective treatment for vaginal yeast infections. Fluconazole works by inhibiting the growth of the yeast causing the infection. It is convenient for patients because it only requires one dose, unlike creams or suppositories that need to be applied for several days.

Choice D rationale:

There are indeed alternatives to antifungal suppositories for treating vaginal yeast infections. As mentioned above, a single dose of fluconazole is one such alternative. Therefore, stating that there is no better alternative to the suppositories is not accurate.