The nurse is caring for a patient who presents in the emergency room with respiratory acidosis.
After assessing the patient, which of the patient's findings is the probable cause of respiratory acidosis?

Choice A rationale

A physician's license is primarily concerned with their medical practice, diagnosis, and treatment of patients. While medication security is important in patient care, the direct responsibility for the secure storage and accurate documentation of narcotics in a facility, according to its policies, falls on the nursing staff. Disciplinary actions related to these specific failures would typically target those directly involved in the lapse of protocol.

Choice B rationale

A pharmacist's license governs the dispensing and management of medications within a pharmacy setting. While pharmacists play a crucial role in the supply chain and providing information about medications, the day-to-day secure storage and inventory control of narcotics within a long-term care facility, as per the facility's policies, is the responsibility of the nurses on duty.

Choice C rationale

A facility's license pertains to the operational standards and overall compliance of the healthcare institution. While the failure to secure narcotics and maintain proper documentation could potentially lead to issues with the facility's licensing if it reflects systemic problems, the initial disciplinary actions for direct violations of nursing policies regarding medication handling would likely target the individual nurses involved.

Choice D rationale

Nurses are directly responsible for adhering to the policies and procedures of the healthcare facility regarding the handling and documentation of medications, especially controlled substances like narcotics. Failing to keep narcotics in a locked, secure location and neglecting to document counts before and after each shift are direct violations of these professional responsibilities and institutional guidelines, potentially leading to disciplinary actions against their nursing licenses.

Choice A rationale

While reporting communicable diseases is a public health responsibility, it is typically mandated by law and health regulations, not specifically a requirement that nurses *always* report to the Board of Nursing in Texas. Reporting protocols usually involve health departments.

Choice B rationale

Parents declining treatment for a child can raise ethical and legal concerns, potentially involving child protective services or the legal system, but it is not always a direct reporting requirement to the Texas Board of Nursing unless it involves professional misconduct by a nurse.

Choice C rationale

A patient's decision to leave against medical advice is a matter of patient autonomy. While nurses document this and ensure the patient understands the risks, it is not typically a mandatory reporting situation to the Texas Board of Nursing unless there are specific concerns about the nurse's conduct related to the discharge.

Choice D rationale

Abuse of older adults by another nurse directly involves the professional conduct and potential harm caused by a licensed nurse. The Texas Board of Nursing is responsible for regulating nursing practice and ensuring patient safety, making it mandatory for nurses to report such instances of misconduct by a colleague.