The graduate nurse is aware that the count of the unit's narcotics and controlled substances at the change of shifts should involve:

Choice A reason: 31 gtts/min assumes 250 mL over 4 hours with 15 gtts/mL; this halves the rate, underdelivering vancomycin, risking subtherapeutic levels and ineffective bacterial killing over the prescribed 2-hour infusion time.

Choice B reason: 62 gtts/min is correct; 250 mL over 2 hours is 125 mL/hr, times 15 gtts/mL equals 1875 gtts total, divided by 120 minutes yields 62 gtts/min, ensuring proper antibiotic delivery.

Choice C reason: 125 gtts/min doubles the rate; 250 mL in 1 hour with 15 gtts/mL is too fast, risking vancomycin toxicity, including renal damage, and exceeding safe infusion guidelines for IVPB.

Choice D reason: 250 gtts/min assumes 250 mL in 30 minutes; this dangerously rapid rate could cause vancomycin-induced red man syndrome or cardiovascular overload, far beyond the ordered 2-hour infusion duration.

Choice A reason: Narcotics are controlled substances requiring strict accountability; two nurses—one ending and one starting the shift—verify counts to ensure accuracy and prevent diversion per regulatory standards.

Choice B reason: The head nurse and pharmacist may oversee inventory, but shift change counts involve direct caregivers for real-time accuracy, not administrative staff, ensuring immediate responsibility and oversight.

Choice C reason: Involving all nurses from both shifts is impractical and unnecessary; it dilutes accountability and increases error risk, as only two are needed to confirm the count efficiently.

Choice D reason: Pharmacy technicians lack authority over unit narcotics, and the charge nurse alone doesn’t suffice; two nurses ensure a witnessed, reliable count per hospital policy and law.