# The nurse gives a medication 1 hour later than scheduled and realizes the delay after administration. The client is stable. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=394112&lang=en  
> language: en  
> subject: Advance Directives  
> category: MOC

## Question

The nurse gives a medication 1 hour later than scheduled and realizes the delay after administration. The client is stable. What should the nurse do?

## Option

1. Request that a colleague document the medication at the actual administration time.
2. Document that the medication was administered at the originally scheduled time.
3. Assess the client, document factual information, and follow facility reporting policy. **✔ Correct answer**
4. The nurse should not document the delay since the client is stable and the medication was given.

**Correct answer: 3**

## Explanation

A medication error or delay requires client assessment, accurate factual documentation, and reporting according to policy. Altering records or asking another nurse to document false information is unethical and unsafe. Incident reporting supports system improvement.

## In-depth explanation

Clinical Judgment
Safety culture uses honest reporting and client assessment after errors.

Memory Tip
Assess, document facts, report.

## Clinical scenario

Clinical Practice Guide
Medication safety systems rely on accurate documentation, event reporting, and follow-up assessment.

Caution
Never falsify a medication administration record.

## Key concepts

- **Medication Error** — A preventable medication-related event that can cause or lead to harm.
- **Incident Report** — A facility safety report used to analyze and reduce future events.
- **Factual Documentation** — Objective charting of what occurred, assessment findings, and actions taken.

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