Level: Advanced
Difficulty: Hard
Subtopic: Oxidation and cellular energy
NCLEX: A 73-year-old client on a telemetry unit is being evaluated for nursing care related to oxidation and cellular en…
Chemistry or biochemistry basics Physiological Adaptation
Case Study
A 73-year-old client on a telemetry unit is being evaluated for nursing care related to oxidation and cellular energy. Assessment data include the nurse notes an unexpected finding during routine assessment. Before a medication-related action, what must the nurse verify?
Question
A. Administer on schedule even when the client is unarousable.
B. Skip allergy checks if the drug was given previously without reaction.
C. Right client, medication, dose, route, time, allergies, indication, and relevant monitoring per protocol.
D. Delegate medication judgment to UAP to save time.
B. Skip allergy checks if the drug was given previously without reaction.
C. Right client, medication, dose, route, time, allergies, indication, and relevant monitoring per protocol.
D. Delegate medication judgment to UAP to save time.
Rationale
Correct answer: C. Right client, medication, dose, route, time, allergies, indication, and relevant monitoring per protocol.
Rationale: Medication safety requires full rights verification and monitoring; shortcuts increase error risk on the NCLEX and at the bedside.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Medication safety requires full rights verification and monitoring; shortcuts increase error risk on the NCLEX and at the bedside.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.