A) This is correct because using two client identifiers, such as name and date of birth, is a standard safety measure to ensure that the right medication is given to the right client.

B) This is correct because checking the expiration date of the medication before administering it is another safety measure to prevent giving expired or ineffective medications to clients.

C) This is correct because comparing the medication label with the prescription three times (before, during, and after preparing the medication) is a recommended practice to prevent errors such as wrong dose, wrong route, or wrong time.

D) This is incorrect because administering the medication as soon as possible after receiving it from the pharmacy may increase the risk of errors due to haste or distraction. The nurse should follow the prescribed schedule and administer the medication within a reasonable time frame.

E) This is incorrect because documenting the medication administration after completing other tasks may lead to forgetting or omitting important information. The nurse should document the medication administration as soon as possible after giving it to the client.

A) This is correct because stopping the infusion and notifying the provider are the priority actions for a client who is experiencing signs and symptoms of anaphylaxis, which is a life-threatening allergic reaction to a medication. The nurse should also prepare to administer epinephrine as prescribed.

B) This is incorrect because administering diphenhydramine as prescribed is not the first action for a client who is experiencing anaphylaxis. Diphenhydramine is an antihistamine that can help relieve some symptoms of an allergic reaction, but it is not effective for reversing bronchoconstriction or hypotension that may occur in anaphylaxis.

C) This is incorrect because monitoring the client's vital signs and oxygen saturation is not the first action for a client who is experiencing anaphylaxis. Although these are important assessments, they are not as urgent as stopping the infusion and notifying the provider.

D) This is incorrect because slowing down the infusion rate and observing for improvement are not appropriate actions for a client who is experiencing anaphylaxis. Slowing down or continuing the infusion may worsen the client's condition and delay treatment.

A) This is incorrect because discarding the vial and obtaining a new one is not necessary actions for a vial of insulin that has a small amount of white precipitate at the bottom. This precipitate indicates that the insulin has crystallized due to cold storage or temperature changes, but it can be resuspended by gently rolling or rotating the vial.

B) This is incorrect because shaking the vial vigorously until the precipitate dissolves is not an appropriate action for a vial of insulin that has a small amount of white precipitate at the bottom. Shaking the vial may cause air bubbles or froth to form, which can affect the accuracy of the dose measurement and administration.

C) This is incorrect because warming the vial in a microwave oven for a few seconds is not a safe action for a vial of insulin that has a small amount of white precipitate at the bottom. Warming the vial in a microwave oven may cause uneven heating or damage to the insulin molecules, which can alter the potency and effectiveness of the medication.

D) This is correct because rolling the vial gently between the palms of both hands is the recommended action for a vial of insulin that has a small amount of white precipitate at the bottom. Rolling the vial gently helps to resuspend the insulin crystals and restore the uniform appearance of the solution.

A) This is correct because blood in the urine (hematuria) is a sign of bleeding that should be reported to the provider. Warfarin is an anticoagulant that can increase the risk of bleeding from any site in the body.

B) This is correct because a headache that lasts for more than an hour is a sign of bleeding that should be reported to the provider. Warfarin can increase the risk of bleeding in the brain (intracranial hemorrhage), which can manifest as a severe or persistent headache, confusion, or neurological deficits.

C) This is correct because black, tarry stools (melena) are a sign of bleeding that should be reported to the provider. Warfarin can increase the risk of bleeding in the gastrointestinal tract (GI bleed), which can manifest as dark or bloody stools, abdominal pain, or vomiting blood.

D) This is correct because a sore throat and a fever are signs of bleeding that should be reported to the provider. Warfarin can increase the risk of bleeding in the mucous membranes (mucosal bleeding), which can manifest as sore throat, mouth ulcers, nosebleeds, or gum bleeding. A fever may indicate an infection that can worsen the bleeding tendency.

E) This is incorrect because bruising on the arms and legs (ecchymosis) is not a sign of bleeding that should be reported to the provider. Warfarin can cause minor bruising due to subcutaneous bleeding, which is usually harmless and does not require treatment. However, if the bruising is extensive, painful, or accompanied by other signs of bleeding, then it should be reported to the provider.

Rapid heart rate and palpitations are potential signs of a medication error, particularly if the client is receiving medication that can affect cardiac function. These symptoms can indicate an adverse reaction or an overdose of certain medications, such as those that affect the cardiovascular system. Monitoring the client's cardiac status is crucial in detecting and managing potential medication errors.

Incorrect choices:

a) Mild headache and dizziness: While these symptoms may be bothersome, they are generally not indicative of a medication error unless they persist or worsen.

b) Temporary nausea and vomiting: Nausea and vomiting can occur as side effects of medications, and they may not necessarily indicate a medication error.

d) Transient muscle weakness and fatigue: Although muscle weakness and fatigue can be associated with medication errors, they are less specific and may be caused by various other factors. Rapid heart rate and palpitations are more concerning in this context.

An allergic reaction to a newly administered medication can be a strong indicator of a medication error. It suggests that the client may have received a medication to which they are allergic or that they were given an incorrect dose or formulation of the medication. Allergic reactions require immediate intervention to prevent further harm.

Incorrect choices:

a) The client reports mild constipation: Mild constipation is a non-specific symptom that may or may not be related to a medication error. It can occur for various reasons, including dietary changes or side effects of the medication.

b) The client's blood pressure remains within normal limits: Blood pressure within normal limits does not necessarily indicate or rule out a medication error. It is important to assess for other specific signs and symptoms related to the medication.

d) The client exhibits improved mood and increased energy: Improved mood and increased energy are positive outcomes that may occur with the appropriate use of medication. They do not suggest a medication error unless accompanied by other concerning signs or symptoms.