# Stage 4 — Generate solutions. Select all actions appropriate for the current patient and organizational response. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=372848&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question Stage 4 — Generate solutions. Select all actions appropriate for the current patient and organizational response. 1 Use the continuous glucose monitor as the only glucose source, stop point-of-care checks after the first result above 70 mg/dL, and resume discharge planning. 2 Repeat point-of-care glucose every 15 minutes until above 70 mg/dL and stable, continue ordered dextrose support, and monitor for recurrent hypoglycemia and potassium changes. 3 Classify the nurse's behavior as reckless and make an automatic licensing-board report before records and choices are reviewed. 4 Preserve the paper order, MAR, dispensing and barcode records, and downtime logs, then complete the confidential safety report according to policy. 5 Use a trained disclosure process to communicate known facts, treatment, uncertainty, and the follow-up plan promptly and empathetically to the client and family. 6 Support the involved nurse, assess system conditions and actual choices before behavior classification, and implement layered safeguards whose use and effects can be audited. ## Explanation Appropriate actions: 2, 4, 5, and 6 Choice 2 manages persistent physiologic risk with confirmatory testing, treatment, and electrolyte surveillance. Choice 4 protects evidence and starts confidential learning. Choice 5 provides timely factual communication without waiting for every investigation result. Choice 6 combines staff support, fair accountability, and measurable system redesign. Why 1 and 3 are unsafe Continuous monitoring does not replace confirmatory point-of-care testing for inpatient hypoglycemia treatment decisions, and one normal result does not end recurrence risk. A just response does not pre-classify behavior or trigger a universal licensing action before fact finding; applicable reporting obligations are determined under law and policy. ## In-depth explanation Patient track Treat the current low, repeat point-of-care testing every 15 minutes until above 70 and stable, and then monitor through the expected excess-insulin effect. Adjust prescribed dextrose support and monitor neurologic status and potassium. Communication track Disclosure is a process, not one scripted meeting with a mandatory attendee list. Share known facts, clinical implications, current care, uncertainty, and how additional findings will be communicated. Learning track The health record contains the patient's condition, care, response, and clinically relevant communication. The confidential safety report remains separate and supports system analysis. Accountability and safeguards Offer peer support and investigate system conditions and choices before classification. Use standardized downtime orders spelling units, verification and reconciliation, alerts and barcode workflows, and policy-defined checks in selected high-risk circumstances; audit reliability and outcomes. ## Clinical scenario Scenario (Stage 4 — Generate solutions) Mr. P needs continued surveillance while the organization begins communication, evidence preservation, staff support, and system learning. Clinical judgment target Select a parallel response bundle without relying on CGM alone or assigning blame before investigation. ## Key concepts - **Layered medication safeguards** — Multiple defenses such as standardized notation, verification, reconciliation, dose-range alerts, barcode workflows, and targeted independent checks, with audits of actual use and effectiveness. - **CANDOR communication process** — A timely, factual, empathetic process that explains known facts, care implications, what is being investigated, and how follow-up will occur through trained organizational support. - **Separate safety report** — A confidential organizational report used for learning and review; it is not substituted for factual clinical documentation in the patient's health record. ## Related questions - [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. 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