The charge nurse reviews concerns about a staff nurse. Which findings require immediate follow-up? Highlight the objective findings that threaten client safety or suggest possible diversion.

Nurses' Notes 0640: The charge nurse begins the controlled-substance safety review after receiving two concerns about a staff nurse. The record shows that the nurse completed the opening count with another RN. During report, the nurse accepted help organizing several routine medication passes. At 0715, the charge nurse observes that the nurse has slurred speech and an unsteady gait. The nurse states that no sleep was obtained overnight but remains assigned to clients. The electronic record confirms that the nurse logged out before leaving a medication terminal. At 0740, a client reports that pain relief followed the documented oral analgesic. The schedule confirms that the nurse attended the required safety huddle before receiving the assignment. The charge sheet shows that the nurse documented the assigned rooms and emergency contact plan. The medication cabinet report then shows that a fentanyl vial is missing after the nurse's access. No waste, administration, or return entry accounts for that vial. A coworker notes that the nurse requested a second check for an insulin dose. At 0805, the charge nurse confirms that the nurse used two identifiers before a scheduled medication. Another client is found with new somnolence and 8 breaths per minute after no opioid was documented. The staff nurse cannot explain the client's change or the missing vial. The schedule shows that the nurse returned from a planned meal break on time. The charge nurse keeps the observations factual and begins the facility safety process.