Leadership Exam 2

The nurse administers medications to the wrong client. During the investigation of the incident, it is determined that the nurse failed to check the client's identification bracelet before administering the medications. The nursing supervisor evaluates the situation and determines that the nurse can be guilty of negligence because of which concept of negligence? A. Strictly prohibited by the Nurse Practice Act B. Strictly prohibited by the institution's own policies C. Defined as a crime that results in the injury of a client D. Defined as the failure to meet established standards of care

D. Defined as the failure to meet established standards of care

As the nurse prepares an older client for discharge, the client states, "I don't know how I'll be able to remember all these instructions and take care of myself at home." Which action should the nurse plan to take to assist the client? A. Delay the discharge until the client can provide effective self-care. B. Ask an out-of-town relative to stay with the client for several days. C. Ask the social worker to follow up with telephone calls to the client. D. Collaborate for a home health care referral for nursing care and support.

D. Collaborate for a home health care referral for nursing care and support.

Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to: A. Work to understand the law as it applies to the client's clinical condition. B. Seek out the nursing supervisor in conflicting situations C. Document all clinical changes in the medical record in a timely manner. D. Assess the client's point of view and prepare to articulate this point of view.

D. Assess the client's point of view and prepare to articulate this point of view.

The nurse working on a rehabilitation unit is assigned to a client with cognitive-perceptual difficulties and fine motor coordination problems. With which rehabilitation team member should the nurse request a consultation? A. Physical therapist B. Speech pathologist C. Recreational therapist D. Occupational therapist

D. Occupational therapist

The scope of Nursing practice is legally defined by: A. Professional nursing organizations B. Physicians in the employing institutions C. Hospital policy and procedure manuals D. State nurses practice acts

D. State nurses practice acts

The nurse does not intervene when a client becomes hypotensive after surgery. The client requires emergency surgery to stop postoperative bleeding later that night. The nurse could potentially face which types of prosecution for failing to act? Select all that apply. A. Felony B. Tort law C. Malpractice D. Statutory law E. Misdemeanor

B and C Tort law deals with wrongful acts intentionally or unintentionally committed against a person or the person's property. The nurse commits a tort offense by failing to act when the client became hypotensive. Malpractice occurs when a duty to the client is established and the nurse neglects to act responsibly and injury or complications occur. Options 1 and 5 are offenses under criminal law. Option 4 describes laws enacted by state, federal, or local governments.

A client tells the home care nurse of a personal decision to refuse external cardiac resuscitation measures. Which is the most appropriate initial nursing action? A. Discuss the client's request with the client's family. B. Notify the health care provider (HCP) of the client's request. C. Document the client's request in the home care nursing care plan. D. Conduct a client conference with the home care staff to share the client's request.

B. Notify the health care provider (HCP) of the client's request. -External cardiac resuscitation is a life-saving treatment that a client may refuse. The most appropriate initial nursing action is to notify the HCP because a written "do not resuscitate" (DNR) prescription from the HCP is needed to ensure that the client's wishes are followed. -The DNR prescription must be reviewed or renewed on a regular basis per agency policy. -Although options A, C, and D may be appropriate, remember that obtaining a written health care provider's DNR prescription must be completed first.

A hospitalized client wants to leave the hospital before being discharged by the health care provider (HCP). Which is the priority nursing intervention? A. Notify the nursing supervisor of the client's plans to leave. B. Ask the client about transportation plans from the hospital. C. Arrange medication prescriptions at the client's preferred pharmacy. D. Discuss the potential consequences of the plans for leaving with the client.

A. Notify the nursing supervisor of the client's plans to leave. -The nurse notifies the nursing supervisor of the client's plan to leave without the health care provider's approval to ensure client safety and to help the nurse manage the situation. This will help the nurse manage the situation in a thoughtful, comprehensive manner and complete nursing interventions that include asking about transportation, arranging medication prescriptions, and discussing the risks and benefits of leaving or remaining in the hospital. -The HCP should be contacted and the client encouraged to remain until the HCP arrives. -The nurse avoids coercion, restraint, or security measures meant to prohibit the client's exit to prevent claims of false imprisonment

The registered nurse witnesses an accident in which the victim has been hit by a car. The nurse stops at the scene of the accident and administers safe care to a victim who sustained a compound fracture of the femur. The victim is hospitalized and later develops sepsis as a result of the fractured femur. The victim files suit against the nurse who provided care at the scene of the accident. Which statement accurately describes the nurse's immunity from this suit? A. The Good Samaritan Law will not protect the nurse. B. The Good Samaritan Law protects lay persons and not professional health care providers. C. The Good Samaritan Law will protect the nurse if the care given at the scene was not negligent. D. The Good Samaritan Law provides immunity from suit even if the nurse accepted compensation for the care provided.

C. The Good Samaritan Law will protect the nurse if the care given at the scene was not negligent.

The clinical nurse educator is conducting an educational session for new nursing graduates and is discussing standards of care. The nurse educator determines that a graduate understands the purpose of standards of care when the graduate makes which statement regarding standards of care? A. They provide excellent care based on current medical research. B. They identify methods of treatment based on the most current technology. C. They include providing competent levels of care based on current practice. D. They include providing care based on specialty guidelines for the client's condition.

C. They include providing competent levels of care based on current practice.

The nurse is performing an admission assessment of a child and notes the presence of old and new bruises on the child's back and legs. The nurse suspects physical abuse. What should be the primary nursing action? A. Report the case to legal authorities. B. File charges against the mother and father of the child. C. Ask the mother to identify the individual who is physically abusing the child. D. Tell the child that she will need to go to a foster home until the situation is straightened out.

A. Report the case to legal authorities.

The nurse is in the cafeteria and tells a physical therapist about a client who is physically abused. During the next visit to physical therapy, the client discovers that the nurse told the therapist about the abuse and is emotionally harmed. As a result of the events in the cafeteria, which legal ramification do the nurse and physical therapist potentially face? Select all that apply. A. They can be charged with libel. B. They can be charged with slander. C. They can be charged with battery. D. None; both can receive privileged client data. E. They can be charged with a HIPAA (Health Insurance Portability and Accountability Act) violation.

B and E Defamation of a client occurs when information is communicated to a third party that causes damage to the client's reputation either verbally (slander) or in writing (libel). In addition, this situation violates the client's right to confidentiality as defined by HIPAA. Common examples of slander are discussing information about a client in public areas or speaking negatively about coworkers. Both the nurse and the therapist can receive privileged information about the client but not in this manner because communicating aspects of the medical record should not occur in a public setting. The nurse and therapist do not know with certainty that the conversation was not overheard by another person.

A client had a colon resection. A nasogastric tube was in place when a regular diet was brought to the client's room. The client did not want to eat solid food and asked that the health care provider be called. The nurse insisted that the solid food was the correct diet. The client ate and subsequently had additional surgery as a result of complications. The determination of negligence is based on which premise? A. The nurse's persistence B. A duty existed and it was breached C. Not notifying the health care provider D. The dietary department sending the wrong food

B. A duty existed and it was breached -For negligence to be proved, there must be a duty, and then a breach of duty; the breach of duty must cause the injury, and damages or injury must be experienced. -Options A, C, and D do not fall under the criteria for negligence. Option B is the only option that fits the criteria of negligence.

Which criterion is needed for someone to give consent to a procedure? A. Unemancipated minor B. An appointed guardianship C. An advocate for a child D. Minimum of 21 years or older

B. An appointed guardianship

The nurse is caring for a client who is receiving intravenous (IV) antibiotics. The nurse enters the client's room to administer the prescribed antibiotic, and the client tells the nurse that the medication burns and that he does not want the medication to be given. The nurse tells the client that the medication is necessary and administers the medication. What can the client legally charge the nurse with as a result of the nursing action? A. Assault B. Battery C. Negligence D. Invasion of privacy

B. Battery

The family of an accident victim who has been declared brain-dead seems amenable to organ donation. What should the nurse do? A. Discourage them from making a decision until their grief has eased B. Listen to their concerns and answer their questions honestly C. Encourage them to sign the consent form right away D. Tell them the body will not be available for a wake or funeral

B. Listen to their concerns and answer their questions honestly

The nurse overhears a client ask the health care provider if the results of a biopsy indicated cancer. The health care provider tells the client that the results have not returned when, in fact, the health care provider is aware that the results of the biopsy indicated the presence of malignancy. The nurse is upset that the health care provider has not shared the results with the client and tells another nurse that the health care provider has lied to the client and that this health care provider probably lies to all of the clients. Which legal tort has the nurse violated by this statement? A. Libel B. Slander C. Assault D. Negligence

B. Slander

The nurse is documenting assessment data of a client showing indications of being physically abused. The inclusion of which information ensures the legal importance of the medical record? Select all that apply. A. Whether the client is willing to prosecute the abuser B. Information regarding the client use of alcohol or drugs C. The client's exact statements regarding the current injury D. A body map indicating the size and location of the injuries E. Details of the client's medical history regarding past injuries

C, D, E The usefulness of the client's medical record in any legal proceedings is impacted by accurate documentation of past medical history and exact quotations of the client's statements regarding the current injuries, especially how they occurred and by whose actions. The inclusion of a body map with the location, size, and shape of injuries is vital. The client's use of alcohol may be a part of the medical history, but that and the client's willingness to pursue the abuse through legal means are not relevant to the documentation's usefulness in a court of law.

A document that lists the medical treatment a person chooses to refuse if unable to make decisions is the: A. Durable power of attorney B. Living will C. Advance directives D. Informed consent

C. Advance directives

The nurse caring for a hospitalized client helps the family prepare a birthday party for the client. When the family arrives and the party starts, the nurse enters the room and takes photographs of the client and the family. What violation has the nurse committed? A. Assault B. Negligence C. Invasion of privacy D. Breach of confidentiality

C. Invasion of privacy Invasion of privacy takes place when an individual's private affairs are unreasonably intruded upon. Invasion of privacy includes taking photographs of the client without the client's consent. Assault occurs when a person puts another person in fear of a harmful or offensive contact. Negligence involves actions that are below the standards of care. Confidentiality is threatened when the nurse discusses the client's private issue or health care issues with another without consent.

The nurse caring for a client with end-stage kidney failure is asked by a family member about advance directives. Which statements should the nurse include when discussing advance directives with the client's family member? Select all that apply. A. A health care proxy can write a living will for a client if the client becomes incompetent and unable to do so. B. Two witnesses, either a relative or health care provider (HCP), are needed when the client signs a living will. C. The determination of decisional capacity of a client is usually made by the health care provider and family. D. Living wills are written documents that direct treatment in accordance with a client's wishes in the event of a terminal illness or condition. E. Under the Patient Self-Determination Act (PSDA), it must be documented in the client's record whether the client has signed an advance directive. F. For advance directives to be enforceable, the client must be legally incompetent or lack decisional capacity to make decisions regarding health care treatment.

C, D, E, F -The two basic advance directives are living wills and durable powers of attorney for health care. -Under the PSDA, it must be documented in the client's record whether the client has signed an advance directive. -For living wills or durable powers of attorney for health care to be enforceable, the client must be legally incompetent or lack decisional capacity to make decisions regarding health care treatment. -The determination of decisional capacity is usually made by the HCP and family, whereas the determination of legal competency is made by a judge. -Living wills are written documents that direct treatment in accordance with a client's wishes in the event of a terminal illness or condition. -Generally, two witnesses, neither of whom can be a relative or HCP, are needed when the client signs the document. -A durable power of attorney for health care designates an agent, surrogate, or proxy to make health care decisions if and when the client is no longer able to make decisions on his or her own behalf; however, a health care proxy cannot legally write a living will for a client.

The nurse performs an admission assessment on a child and suspects physical abuse. Based on this suspicion, what is the primary legal nursing responsibility? A. Refer the family to the appropriate support groups. B. Assist the family in identifying resources and support systems. C. Report the case in which the abuse is suspected to the local authorities. D. Document the child's physical assessment findings accurately and thoroughly.

C. Report the case in which the abuse is suspected to the local authorities. Abuse is the nonaccidental physical injury or the nonaccidental act of omission of care by a parent or person responsible for a child. It includes neglect and physical, sexual, and emotional maltreatment. The primary legal nursing responsibility when child abuse is suspected is to report the case. Suspected child abuse should be reported to the local authorities. Although documentation of assessment findings, assisting the family, and referring the family to appropriate resources and support groups are important, the primary legal responsibility is to report the suspected case.

A client diagnosed with leukemia asks the nurse questions about preparing a living will. Which recommendation from the nurse should be the best method of preparing this document? A. Talk to the hospital chaplain. B. Obtain advice from an attorney. C. Consult the American Cancer Society. D. Discuss the request with the health care provider (HCP).

D. Discuss the request with the health care provider (HCP). Living wills are legal documents known as advance directives wherein the client delineates the withdrawal or withholding of treatment when the client is incompetent. Living wills should not be confused with a will that bequeaths personal property and specifies other actions at the time of the client's death. The client starts the process of writing a living will by discussing treatment options and other related issues with the HCP. In addition, the client should discuss this issue with the family. Although options 1 and 2 may be helpful, contacting them is not the initial step because both professionals lack the medical information the client needs to make an informed decision; however, the lawyer may be involved after discussion with the HCP and family. The American Cancer Society may have pertinent information on living wills; however, the information is not individualized to the client's needs.

The nurse administers a fatal dose of a cardiac medication to a client. During the subsequent investigation, it was determined that the nurse did not check the client's vital signs before administering the medication. This failure to complete an appropriate assessment is addressed under which function of the Nurse Practice Act? A. Defining the specific educational requirements for licensure B. Recommending disciplinary action for nurses who violate the law C. Describing the scope of practice of licensed and unlicensed care providers D. Identifying the process for disciplinary action if standards of care are not met

D. Identifying the process for disciplinary action if standards of care are not met In the situation described in the question, acceptable standards of care were not met (the nurse failed to adequately assess the client before administering a medication). Option D refers specifically to the situation described. Options A, B, and C do not relate to standards of care.

A client tells the nurse that he has seen many articles in the health care section of the newspaper about case management. The client asks the nurse what this means. Which response should the nurse make to the client? A. "It represents an interdisciplinary health care delivery system." B. "One nurse takes care of one client and is responsible for that client." C. "One nurse supervises all of the other employees when they care for clients." D. "A single case manager plans the care for all of the clients in the nursing unit."

A. "It represents an interdisciplinary health care delivery system."

The nurse's responsibilities when witnessing an informed consent include which actions? Select all that apply. A. Describing treatment alternatives if any exist B. Assuring that the client voluntarily gave consent C. Assuring that the signature was written by the client D. Evaluating the client's understanding of the risks involved E. Assessing for any indications that the client is not competent

B, C, D, E

Which clinical situation should be viewed as assault? A. The nurse threatens to apply restraints to a client who is exhibiting aggressive behavior. B. The client requests a medical discharge, but the nurse physically forces the client to stay. C. The charge nurse sends an email to a staff member which includes a poor performance evaluation about another person. D. The nurse overhears the health care provider making derogatory remarks to the client about the nurse's level of competency.

A. The nurse threatens to apply restraints to a client who is exhibiting aggressive behavior. -An assault occurs when a person puts another person in fear of a harmful or offensive act. -Battery involves offensive touching or the use of force by a perpetrator without the permission of the victim. -Defamation takes place when a falsehood is said (slander) or written (libel) about a person that results in injury to that person's good name and reputation.

The nurse notes old and new ecchymotic areas on an older adult client's arms and buttocks upon admission. The client tells the nurse in confidence that her family members frequently hit her. Which statement should the nurse use in response? A. "I have a legal obligation to report this type of abuse." B. "Let's get these treated, and I will maintain confidence." C. "Let's talk about ways to prevent someone from hitting you." D. "If this happens again, you must call the emergency department."

A. "I have a legal obligation to report this type of abuse." -The nurse should inform the client that nurses cannot maintain confidence about alleged abusive behavior and that the nurse must report situations related to abuse. -The nurse avoids bargaining with the client about treatment to maintain a confidence that the nurse is legally bound to report. -Options C and D delay protective action and place the client at risk for future abuse.

A registered nurse suspects that a colleague is substance impaired and notes signs of alcohol intoxication in the colleague. The Nurse Practice Act requires that the registered nurse take which action? A. Talk with the colleague. B. Call the impaired nurse organization. C. Report the information to a nursing supervisor. D. Ask the colleague to go to the nurses' lounge to sleep for a while.

C. Report the information to a nursing supervisor.

he nurse manager is developing an educational session for nursing staff on the components of informed consent and the information to be shared with a client to obtain informed consent. Which information should the nurse manager include in the session? Select all that apply. A. The client needs to be informed of the prognosis if the test, procedure, or treatment is refused. B. The client cannot refuse a test, procedure, or treatment once the test, procedure, or treatment is started. C. The name(s) of the persons performing the test or procedure or providing treatment should be documented on the informed consent form. D. A description of the complications and risks of the test, procedure, or treatment, as well as anticipated pain or discomfort, needs to be explained to the client. E. The nurse is responsible for obtaining the client's signature on an informed consent form even if the client has questions about the test, procedure, or treatment to be performed.

A, C, D -Informed consent is a person's agreement to allow something to happen based on full disclosure of risks, benefits, alternatives, and consequences of refusal. -The health care provider (HCP) is responsible for conveying information and obtaining the informed consent. -The nurse may be the person who actually ensures that the client signs the informed consent form; however, the nurse does this only after the HCP has instructed the client, and it has been determined that the client has understood the information. -The following factors are required for informed consent: a brief, complete explanation of the test, procedure, or treatment; names and qualifications of persons performing and assisting in the test, procedure, or treatment; a description of the complications and risks, as well as anticipated pain or discomfort; an explanation of alternative therapies to the proposed test, procedure, or treatment, as well as the risks of doing nothing; and his or her right to refuse the test, procedure, or treatment even after it has been started.

Which are the characteristics of case management? Select all that apply. A. A case manager usually does not provide direct care. B. Critical pathways and CareMaps are types of case management. C. A case manager does not need to be concerned with standards of cost management. D. A case manager collaborates with and supervises the care delivered by other staff members. E. The evaluation process involves continuous monitoring and analysis of the needs of the client and services provided. F. A case manager coordinates a hospitalized client's acute care and follows up with the client after discharge to home.

A, D, E, F Case management is a care management approach that coordinates health care services to clients and their families while maintaining quality of care and minimizing health care costs. Case managers usually do not provide direct care; instead they collaborate with and supervise the care delivered by other staff members and actively coordinate client discharge planning. A case manager is usually held accountable for some standard of cost management. A case manager coordinates a hospitalized client's acute care, follows up with the client after discharge to home, and is responsible and accountable for appraising the overall usefulness and effectiveness of the case managed services. This evaluation process involves continuous monitoring and analysis of the client's needs and services provided. Critical pathways or CareMaps are not types of case management; rather, they are multidisciplinary treatment plans used in a case management delivery system to implement timely interventions in a coordinated care plan.

An adult client who has a severe mental impairment is scheduled for gallbladder surgery. With regard to the informed consent, which should the nurse implement first to facilitate the scheduled surgery? A. Check for the identity of the client's legal guardian. B. Inform the legal guardian about advance directives. C. Arrange for the surgeon to provide informed consent. D. Ensure that the legal guardian signed the informed consent.

A. Check for the identity of the client's legal guardian. A mentally impaired client is not competent to sign an informed consent, so the nurse should first verify the identity of the client's legal guardian. This action fulfills part of the nurse's duty in informed consent, helps avoid improperly signed documents, and directs the surgeon to the legal representatives of the client's interests. The client and/or legal guardian is asked about the existence of an advance directive at the time of admission, so this should have already been done, making option B incorrect. The surgeon is responsible for obtaining the informed consent, but based on the options provided, option C is not the first nursing action. Likewise, option D is not the first action; the nurse checks identity of the legal guardian first.

A client asks the nurse how to become an organ donor. What should the nurse include in the discussion? A. The client can donate by written consent. B. A family member must witness the consent. C. The donor must be older than 21 years of age. D. A family member must be present when a client consents to organ donation.

A. The client can donate by written consent. The client has the right to donate her or his own organs for transplantation, and any person who is 18 years of age or older may become an organ donor by written consent without the permission or presence of the family. In the absence of suitable documentation, a family member or legal guardian can authorize donation of the decedent's organs.

The nurse identifies which clinical situation as slander? A. The health care provider tells a client that the nurse "does not know anything." B. The nurse tells a client that a nasogastric tube will be inserted if the client continues to refuse to eat. C. The nurse restrains a client at bedtime because the client gets up during the night and wanders around. D. The laboratory technician restrains the arm of a client refusing to have blood drawn so that the specimen can be obtained.

A. The health care provider tells a client that the nurse "does not know anything." Defamation takes place when a falsehood is said (slander) or written (libel) about a person that results in injury to that person's good name and reputation. Battery involves offensive touching or the use of force by a perpetrator without the permission of the victim. An assault occurs when a person puts another person in fear of a harmful or offensive act.

Which of the following is an example of nursing malpractice? A. The nurse administers penicillin to a patient with a documented history of allergy to the drug. The patient experiences an allergic reaction and has cerebral damage resulting from anoxia. B. The nurse applies a hot water bottle or a heating pad to the abdomen of a patient with abdominal cramping. C. The nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus. D. The nurse administers the wrong medication to a patient and the patient vomits. This information is documented and reported to the physician and the nursing supervisor.

A. The nurse administers penicillin to a patient with a documented history of allergy to the drug. The patient experiences an allergic reaction and has cerebral damage resulting from anoxia. -Option A: The three elements necessary to establish a nursing malpractice are nursing error (administering penicillin to a patient with a documented allergy to the drug), injury (cerebral damage), and proximal cause (administering the penicillin caused the cerebral damage). -Option B: Applying a hot water bottle or heating pad to a patient without a physician's order does not include the three required components. -Option C: Assisting a patient out of bed with the bed locked in position is the correct nursing practice; therefore, the fracture was not the result of malpractice. -Option D: Administering an incorrect medication is a nursing error; however, if such action resulted in a serious illness or chronic problem, the nurse could be sued for malpractice.

The nurse is developing an educational session on client advocacy for the nursing staff. The nurse should plan to tell the nursing staff that which interventions are examples of the nurse acting as a client advocate? Select all that apply. A. Obtaining an informed consent for a surgical procedure B. Providing information necessary for a client to make informed decisions C. Providing assistance in asserting the client's human and legal rights if the need arises D. Ignoring the client's religious or cultural beliefs when assisting the client in making an informed decision E. Defending the client's rights by speaking out against policies or actions that might endanger the client's well-being

B, C, E -In the role of client advocate, the nurse protects the client's human and legal rights and provides assistance in asserting those rights if the need arises. -The nurse advocates for the client by providing information needed so that the client can make an informed decision. -The nurse also defends clients' rights in a general way by speaking out against policies or actions that might endanger the client's well-being or conflict with his or her rights. -Informed consent is part of the health care provider-client relationship; in most situations, obtaining the client's informed consent does not fall within the nursing duty. Even though the nurse assumes the responsibility for witnessing the client's signature on the consent form, the nurse does not legally assume the duty of obtaining informed consent. -The nurse needs to consider the client's religion and culture when functioning as an advocate and when providing care. The nurse would not ignore the client's religious or cultural beliefs in discussions about treatment plans, so that an informed decision can be made.

A client who has heart failure receives an additional dose of a diuretic after the daily dose. The nurse assesses the client 15 minutes after administering the medication and reminds the client to save all urine in the bathroom. Thirty minutes later, the nurse finds the client on the floor, unresponsive, and bleeding from a laceration. Determine the issues that support the client's malpractice claim. Select all that apply. A. Failure to replete body fluids B. Increased risk of hypotension C. Excessive diuretic administration D. Lack of follow-up nursing actions E. Failure to teach the client properly F. Increased need to protect the client

B, D, E, F -To prove malpractice against the nurse, the plaintiff must prove that the nurse owed a duty to the client, that there was a breach of that duty, injury was caused by the breach, and this resulted in damages. -The client has an increased risk of hypotension because hypotension is a common adverse effect of many diuretics. -This is the second dose and the client has heart failure. It may be difficult for the client to prove that the second dose of diuretic caused the injury because of the client's heart failure. -The client can prove that the nurse did not provide protection by failing to provide proper teaching and perform correct and timely nursing interventions after administering the diuretic. -After the first 15-minute check, the nurse should increase client monitoring to ensure client compliance with safety measures. -Replacing fluid volume is not indicated because the nurse did not note hypovolemia or hypotension (option A); besides, the goal of therapy is to reduce total body fluid. -Hypotension can occur especially after a repeat dose; therefore, the nurse should instruct the client to remain in bed and be provided with a urinal.

The nurse notes that a postoperative client has not been obtaining relief from pain with the prescribed opioid analgesics when a particular licensed coworker is assigned to the client. Which action is most appropriate for the nurse to take? A. Reassign the coworker to the care of clients not receiving opioids. B. Notify the health care provider that the client needs an increase in opioid dosage. C. Review the client's medication administration record immediately and discuss the observations with the nursing supervisor. D. Confront the coworker with the information about the client having pain control problems and ask if the coworker is using the opioids personally.

C. Review the client's medication administration record immediately and discuss the observations with the nursing supervisor. In this situation, the nurse has noted an unusual occurrence, but before deciding what action to take next, the nurse needs more data than just suspicion. This can be obtained by reviewing the client's record. State and federal labor and opioid regulations, as well as institutional policies and procedures, must be followed. It is therefore most appropriate that the nurse discuss the situation with the nursing supervisor before taking further action. To reassign the coworker to clients not receiving opioids ignores the issue. The client does not need an increase in opioids. A confrontation is not the most advisable action because it could result in an argumentative situation.