Which of the following actions by the nurse would meet the standard of care?
1. The nurse questioned a physician about a prescription where the dose was higher than the recommended dose.
2. The nurse medicated a client who reported severe chest pain with aspirin and then called the physician to get a prescription.
3. The nurse brings a breakfast tray into the client's room and puts in on the counter away from the client who is vomiting and nauseous.
4. A nurse leaving the facility at the end of the shift witnesses a client fall. The nurse calls for help and tells the other nurse that during the next shift he or she will fill out the incident report.
1. The nurse questioned a physician about a prescription where the dose was higher than the recommended dose.
Explanation: 1. Questioning a medication dosage outside the normal range is a situation in which a reasonable nurse would pursue a similar action and would be considered the standard of care.
2. Medicating a client with aspirin for severe chest pain without a prescription and then notifying the physician would not be considered standard care.
3. The nurse should have withheld the breakfast tray from a client who is nauseated and vomiting or at least left it outside the client's room so the client would not smell the food and possibly exacerbate the symptoms.
4. Assisting a patient who has fallen is a situation in which a reasonable nurse would pursue a similar action and would be considered the standard of care. The nurse would then need to fill out the incident report at the time of the incident, not on the next shift.
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