A nurse administers metoprolol 50 mg PO to a client instead of the prescribed metformin 500 mg PO. The client's heart rate drops from 78/min to 52/min and blood pressure is 98/60 mm Hg. Which actions should the nurse take? Select all that apply.

After a medication error, the priority is to assess the client for adverse effects, including level of consciousness and respiratory status, as metoprolol can cause bradycardia and hypotension. The health care provider must be notified immediately to obtain further orders and mitigate harm. The nurse should document the facts of the error and the client's response objectively in the health record. Frequent vital sign monitoring is essential to detect deterioration. An incident report should be completed but never placed in the client's chart or referenced in the health record. Asking a colleague to double-check the medication administration record is not an immediate action after the error has occurred.