The following scenario demonstrates your accountabilities when you make a mistake in practice. Pat, a newly registered RN, recently started working in a stroke rehabilitation unit. During a busy day shift, Pat accidentally gives amitriptyline to the wrong patient. Once Pat realizes her mistake, she’s horrified. She knows she did the necessary safety checks before administering the medication. On review, she realizes that the patient shares a last name with another patient on the unit, and she mixed up the patients. Pat monitors the patient closely. There are no immediate adverse effects. Since the patient seems unharmed, Pat wonders if the health care team, or the patient and their family, need to be informed. She’s embarrassed about her mistake and doesn’t want to tell anyone. She’s unsure what to do next. A commitment to her patient Pat considers all the ways her mistake could affect the patient. She continues to closely monitor the patient for adverse effects. She also thinks about her therapeutic relationship with the patient. Pat knows that trust is at the core of a therapeutic relationship, and that lying or omitting important information can irreparably damage that relationship. Pat realizes that in order to maintain the therapeutic relationship, she must be honest with the patient and include them as partners in their care. Pat knows that she must always put patients first. She realizes that keeping her mistake secret in order to protect her professional reputation would be putting her own needs before the needs of her patient. A commitment to creating a quality practice setting Pat also reflects on why she made the mistake and the factors that led her to mix up the patients. If she made this mistake, it’s possible other members of the health care team might as well. Pat realizes that in order to prevent a similar error from happening again, she needs to speak up. She can advocate for her patients and provide them with the best possible care by making sure no one else makes a similar mistake. A decision is made Pat tells her charge nurse about the mistake. Together, they discuss ways to prevent someone else on the health care team from making a similar mistake. Pat also tells her charge nurse that she has never had to disclose a mistake to a patient before. Pat realizes this is a learning need and asks for her charge nurse’s help. Together, they discuss the best way to inform the patient. After disclosing the error to the patient, Pat reflects on the day’s events and her role in them. She knows the error is an opportunity to learn. She thinks about her strengths, opportunities for improvement and key learning needs. Putting patients first When Pat disclosed her mistake to the team, she made the right choice to put her patient’s needs ahead of her own. She was also advocating for a quality practice setting and ensuring that future patients will receive safe care. By speaking up and putting her patient first, Pat was upholding the principles in the nurses’ Code of Conduct and meeting her accountabilities outlined in the Professional Standards, Revised 2002and Medicationpractice standards. She was also meeting her professional duty to report any error, behaviour, conduct or system issue that affects patient safety. A nurse knows that patient education has been effective when the patient states “I will rotate the location where I give myself injections.” Which statement by the patient is an indication to use the Z-track method? “The last shot like that turned my skin colors.” A 2-year-old child is ordered to have ear irrigation performed daily. The nurse correctly performs the procedure by Pulling the auricle down and back to straighten the ear canal. A patient has an order to receive 10 units of U-50 insulin. The nurse is using a U-100 syringe. How many units should the nurse draw up in the syringe and administer? A patient has an order to receive 20 units of U-50 insulin. The nurse is using a U-100 syringe. How many units should the nurse draw up in the syringe and administer? The patient is to receive phenytoin (Dilantin) at 0900. The nurse knows that the ideal time to draw a trough level is A patient who has been receiving intermittent chemotherapy through a peripheral IV site is ordered to receive a high dose of vancomycin through the same vein. Why does this concern the nurse? Chemotherapy is irritating to the vascular system and may cause the vein to infiltrate. A physician orders 1000 mL of normal saline to infuse at a rate of 50 mL/hr. The nurse plans on hanging a new bag at what time? The nurse is preparing to administer a 0.5-mL rabies vaccine into the deltoid muscle of a patient. Which needle size is best for the procedure? The nurse knows that the purpose of aspiration on IM injections is to Ensure proper placement of the needle. The nurse is giving an IM injection. Upon aspiration, the nurse notices blood return in the syringe. What should the nurse do? Withdraw the needle and prepare the injection again. The nurse is planning to administer a tuberculin test with a 27-gauge, 3/8-inch needle. The nurse should insert the needle at an angle of _____ degrees. The nurse knows to assess for signs of medication toxicity within older adults because of which physiological change? Reduced glomerular filtration A registered nurse interprets that a scribbled medication order reads 25 mg. The nurse administers 25 mg of the medication to a patient, and then discovers that the dose was incorrectly interpreted and should have been 15 mg. Who is ultimately responsible for the error? A patient is to receive medication through a nasogastric tube. What is the most important nursing action to ensure effective absorption? Clamp suction for 30 to 60 minutes after medication administration. Aspirin is an analgesic, antipyretic, antiplatelet, and anti-inflammatory agent. A physician writes for aspirin 650 mg every 4 to 6 hours prn: febrile. For which patient would this order be appropriate? 62-year-old female with pneumonia A patient is in need of immediate pain relief for a severe headache. The nurse knows that which medication will be absorbed the quickest? Hydromorphone (Dilaudid) 4 mg IV A drug requires a low pH to be metabolized. Knowing this, the nurse anticipates that the medication will be administered by which route? The nurse knows that an idiosyncratic event with the stimulant pseudoephedrine (Sudafed) is occurring when the patient Falls asleep during daily activities. An order is written for (phenytoin) Dilantin 500 mg IM q3-4h prn for pain. The nurse recognizes that treatment of pain is not a standard therapeutic indication for this drug. The nurse believes that the prescriber meant to write for hydromorphone (Dilaudid). What should the nurse do? Call the prescriber to clarify and justify the order. A patient needs assistance excreting a gaseous medication. What is the correct nursing action? Encourage the patient to cough and deep-breathe A nurse has withdrawn a narcotic from the medication dispenser. Upon checking the drug against the medication administration record, the nurse notices that the narcotic order has expired. What should be the nurse’s first action? Return the medication to the medication dispenser according to protocol The nurse knows that patient education about a buccal medication has been effective when the patient states “I should let the medication dissolve completely.” What is the nurse’s priority action to protect a patient from medication error? Requesting that the prescriber write out an order, rather than giving a verbal order The patient is in severe pain and is requesting a prn medication before the prn time interval has elapsed. The nurse’s priority is to Call the prescriber and request a stat order. A patient is at risk for aspiration. What nursing action is most appropriate? Have the patient self-administer the medication. A confused patient refuses his medication. What is the nurse’s first response? Educates the patient about the importance of the medication A patient who is being discharged today is going home with an inhaler. The patient is to administer 2 puffs of his inhaler twice daily. The inhaler contains 200 puffs. When should the nurse appropriately advise the patient to refill his medication? 6 weeks from the start of using the inhaler The nurse knows that a subcutaneous injection takes longer to absorb because Fewer blood vessels are found under the subcutaneous level. The nurse realizes which patient is at greatest risk for an unintended synergistic effect? 72-year-old who is seeing four different specialists Which patient using an inhaler would benefit most from using a spacer? 25-year-old with multiple sclerosis The prescriber wrote for a 40-kg child to receive 25 mg of medication 4 times a day. The therapeutic range is 5 to 10 mg/kg/day. What is the nurse’s priority? Notify the physician that the prescribed dose is below the therapeutic range. The nurse is administering an intravenous medication that is to be administered over 10 minutes. Which method should the nurse choose to efficiently administer the medication? Attach separate tubing and set the medication syringe in a mini-infusion pump. A nurse is caring for a patient who is in hypertensive crisis. When the nurse is flushing the patient’s peripheral IV, the patient complains of pain. Upon assessment, the nurse notices a red streak that is warm to the touch. What is the nurse’s initial action? Apply a cool compress to the site. 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 of the following actions should the nurse complete first? Return to the room to check and assess the patient. The nurse knows that caring for two patients with the same last name can lead to a medication error involving which right of medication administration? A patients states that she would prefer not to take her daily allergy pill this morning because it makes her too drowsy throughout the day. The nurse responds therapeutically by saying, “Let’s change the time you take your pill to 9 PM, so the drowsiness occurs when you would normally be sleeping. A provider has ordered a STAT medication to be administered. The nurse knows that the best route of administration is A nurse is attempting to administer medication to a child, but the child refuses to take the medication. The nurse asks for the parent’s cooperation by saying “I will prepare the medication for you and observe if you would like to try to administer the medication.” A 64-year-old quadriplegic patient needs an IM injection of antibiotic. What is the best site for the administration? Which nursing action is the number one priority for ensuring that medication stays in the target therapeutic range? Drawing the peak and trough levels at the same time each day Which of the following demonstrates proper oral medication administration? Placing all of the patient’s medications in the same cup, except medications with assessments A patient who is receiving IV fluids notifies the nurse that his arm feels tight. Upon assessment, the nurse notes that the arm is swollen and cool to the touch. What should the nurse’s first action be? Discontinue the IV site, and apply a warm compress. A patient informs the nurse that his urine is starting to look discolored. How should the nurse respond? “Other than the discoloration, has anything changed with your urination?” The physician orders 4 mg of oxycodone to be delivered every 6 hours. After 4 hours, the patient is complaining that she is in more pain. The nurse advises the physician to make which medication adjustment? Divide the dose in half and administer 2 mg every 3 hours. Which of the following are methods to reduce the risk of needlestick injury? Have sharps boxes emptied when three-quarters full. Never force a needle into the sharps disposal. What methods are used to properly discard narcotics? Washing liquids down the sink |
The nurse realizes which patient is at greatest risk for an unintended synergistic effect?
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