When monitoring medication inventories for possible diversion or theft by nurses who abuse chemicals, what medication classifications should be monitored most closely? [SELECT ALL THAT APPLY]

A. This task is appropriate for UAP to perform, as it involves basic hygiene and does not require nursing judgment or clinical assessment. UAP can assist with routine oral care under the direction of the RN.
B. Assisting with position changes is a basic care activity that UAP can perform. This task helps prevent pressure ulcers and maintains client comfort, and it does not require the clinical judgment of a nurse.
C. Administering IV medications or fluids is a nursing task that requires specific training and knowledge of nursing assessments, potential complications, and monitoring. This task should only be performed by a licensed nurse, not by UAP.
D. UAP can document basic measurements such as urine output, as this is a straightforward task that does not require clinical judgment. However, the RN should ensure that the UAP understands how to accurately measure and record this information.
E. While UAP can observe and report general changes, monitoring for clinical indications of dehydration requires nursing assessment skills and judgment. This task should be performed by an RN.
F. While UAP can weigh clients, the assessment of weight trends requires clinical judgment and interpretation of data, which falls under the responsibilities of a licensed nurse. The RN should evaluate and interpret the data regarding the client's health status.

A. While it's important to obtain a formal DNR order, the nurse should not delay providing emergency care while waiting for the order. The client's immediate needs take precedence.
B. The risk manager can provide guidance and support, but they cannot provide immediate medical care. The nurse's priority should be to provide emergency care to the client.
C. Even in the absence of a formal DNR order, the nurse has a legal and ethical duty to provide emergency care to a client who is in cardiac or respiratory arrest.
D. This is the most appropriate action. The nurse should immediately call the emergency response team to initiate resuscitation efforts. While waiting for the team to arrive, the nurse should continue to provide basic life support measures, such as CPR and rescue breathing. Once the emergency response team arrives, they will take over the resuscitation efforts and obtain a formal DNR order from the provider if necessary.