An assistive personnel (AP) tells the nurse manager that she observed a nurse on the unit removing a small amount of morphine from syringes prior to administering the medication to clients. Which of the following actions should the nurse manager take first?

Rationale:
A. A client discovers that his dentures are missing is correct because an incident report is completed whenever an unexpected event occurs that could potentially harm a client or result in a loss. Missing dentures represent a client safety or property issue that requires documentation and follow-up to prevent further complications or grievances.

B. The nurse has a disagreement with the nursing supervisor about inadequate staffing is incorrect because interpersonal disagreements or staffing concerns are handled through management or human resources channels, not incident reports. These situations do not constitute reportable client safety events.

C. The nurse identifies a broken piece of equipment is incorrect because simply discovering broken equipment does not constitute an incident unless it directly caused or could have caused harm to a client. The equipment should be reported through maintenance procedures rather than an incident report unless it resulted in injury.

D. A staff member does not show up to work her assigned shift is incorrect because this is an administrative or staffing issue. While it affects workflow, it does not meet the criteria for an incident report, which focuses on unexpected events affecting client safety or property.

Rationale:
A. "I should encourage clients to receive an annual flu immunization" is correct because preventive measures, such as immunizations, reduce the incidence of illness and subsequent hospitalizations or complications. Encouraging clients to take preventive steps lowers overall healthcare costs by decreasing the need for acute care, emergency visits, and extended treatment.

B. "I should wait to empty my client's drainable colostomy until it is three-fourths full" is incorrect because delaying emptying can increase the risk of skin breakdown, leakage, or infection. Poor management of ostomy care can lead to complications, which increases, rather than decreases, healthcare costs.

C. "I should recommend that my clients who have an established tracheostomy use sterile technique at home to provide ostomy care" is incorrect because at-home care for an established tracheostomy or ostomy typically involves clean, not sterile, technique unless otherwise indicated. Using sterile technique unnecessarily increases supply costs without improving outcomes, which is not cost-effective.

D. "I should delegate providing closed irrigation to the assistive personnel (AP)" is incorrect because closed irrigation involves a sterile procedure and assessment, which requires nursing judgment. Delegating this task to APs is unsafe and could result in complications, ultimately increasing costs due to potential adverse outcomes.