The nurse is preparing to administer medications to two patients with the same last name. After the administration, the nurse realizes that she did not check the identification of the patient before administering medication. Which action should the nurse complete first?
Complete proper documentation of the medication error in the patient’s chart.
Return to the room to check and assess the patient.
Administer the antidote to the patient immediately.
Alert the charge nurse that a medication error has occurred.
The Correct Answer is B
A: Completing proper documentation of the medication error is important but should not be the first action. Immediate assessment of the patient is more critical.
B: Returning to the room to check and assess the patient is the first priority. The nurse needs to determine if the patient has experienced any adverse effects from the medication error and provide appropriate care.
C: Administering the antidote to the patient immediately is only necessary if the medication given has a known antidote and the patient is showing signs of adverse effects. Assessment should come first.
D: Alerting the charge nurse that a medication error has occurred is important for reporting and follow-up but should follow the immediate assessment and care of the patient.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A: A trochanter roll is used to prevent external rotation of the hips, not to prevent plantar flexion contractures.
B: A sheepskin heel pad provides cushioning and helps prevent pressure ulcers on the heels but does not prevent plantar flexion contractures.
C: A footboard is used to prevent plantar flexion contractures by keeping the feet in a neutral position. This helps maintain proper alignment and prevents the muscles and tendons from shortening.
D: An abduction pillow is used to maintain hip abduction, typically after hip surgery, and does not prevent plantar flexion contractures.
Correct Answer is C
Explanation
A: Hyperkalemia refers to high potassium levels, which can occur in ESKD but does not directly cause shortness of breath, swelling, or crackles in the lungs.
B: Hyponatremia refers to low sodium levels, which can occur in ESKD but does not directly cause the symptoms described.
C: Hypervolemia, or fluid overload, is the most likely cause of the client’s symptoms. ESKD can lead to fluid retention, causing shortness of breath, swelling, crackles in the lungs, and elevated blood pressure.
D: Hypovolemia refers to low blood volume, which would not cause the symptoms of fluid overload described in the client.
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