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Veracity means telling the truth and being honest with clients, which is not demonstrated in this scenario.

Utility focuses on the greatest good for the greatest number, not on preventing individual harm in a direct care setting.

Autonomy is respecting the client’s right to make their own decisions about care, but it does not apply to removing environmental hazards.

A client refusing therapy is not an unusual occurrence and does not require an incident report—this should be documented in the nursing notes instead.

A client throwing tissues may be disruptive, but since no injury or safety issue occurred, an incident report is not required. Documentation of behavior is sufficient.

Administering medication 30 minutes late is generally within the accepted time frame for most scheduled medications and does not require an incident report.

Administering an initial NG tube feeding requires assessment of tube placement and tolerance, which are nursing responsibilities—not within the AP’s scope.

Checking a client’s pain level involves assessment, which cannot be delegated to an AP—it requires a licensed nurse.

Instructing a client about splinting an incision involves teaching, which is the nurse’s role, not the AP’s.

Shortness of breath with left neck and shoulder pain may indicate cardiac ischemia and is urgent, but it is not as immediately life-threatening as uncontrolled external bleeding.

A raised red skin rash is uncomfortable and may indicate allergy or infection, but it is not life-threatening at this moment.

Flank pain with diaphoresis suggests possible renal calculi or another serious condition, but it does not take priority over airway, breathing, or circulation compromise.

It is not appropriate for the client to independently mark the operative site; this could lead to errors. Site marking must be done by the surgical team per protocol.

Contacting the surgery department does not directly resolve the client’s confusion or ensure proper informed consent.

Proceeding with surgery despite the client’s expressed concern would be unsafe and violates the principles of informed consent and patient safety.

Admission assessments must be completed by an RN, not an LPN.

Administration of blood products (RBCs) requires an RN due to the need for close monitoring and rapid intervention for transfusion reactions.

Initiating oral nutrition after a stroke involves swallowing assessment and risk for aspiration, which must be performed by an RN.

A client with premature rupture of membranes at 32 weeks requires specialized obstetrical knowledge and monitoring for complications such as infection and preterm labor.

A client with preeclampsia on misoprostol induction requires close fetal and maternal monitoring, which demands specialized obstetric expertise.

A client with gestational diabetes undergoing nonstress tests needs interpretation of fetal monitoring results, which is outside the scope of practice for a floated med-surg RN.

Client concerns about meals should be addressed but do not require an incident report—these can be managed through dietary services or routine documentation.

Difficulty obtaining medication from the pharmacy is a systems issue, but it does not directly involve a client safety event and therefore does not require an incident report.

A client’s refusal of medication is their right and should be documented in the medical record, not reported as an incident.

An aPTT of 34 seconds is within the expected reference range for a client on heparin, so no interdisciplinary conference is required.

A client with type 1 diabetes using an insulin pump requires routine management and education, which can be handled by the primary nurse without a formal conference.

An albumin level of 4.2 g/dL is within the normal range, so this client is not at increased risk for pressure injuries requiring interdisciplinary planning.

Counseling the staff nurse directly is not the charge nurse’s role in this situation. Formal evaluation and intervention are handled through appropriate channels, not peer-to-peer counseling.

The facility’s ethics committee does not handle suspected staff impairment. Reporting goes through management and possibly employee health or human resources.

Assigning “safe” clients to the nurse does not address the potential risk to all clients and enables impaired practice, which is unsafe and unethical.