# Place the nurse's actions in order after detecting a wrong-client insulin near miss before administration.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=396368&lang=en  
> language: en  
> subject: Performance Improvement  
> category: MOC

## Question

Place the nurse's actions in order after detecting a wrong-client insulin near miss before administration.

Submit a patient-safety event report with objective facts and participate in follow-up aimed at preventing recurrence.

Use two identifiers to verify the intended client, medication, current order, and whether any dose reached either client.

Stop the administration and keep the insulin pen and open MAR separated from both clients.

Assess the intended and potentially affected client as indicated, including the current glucose and any evidence of exposure.

Notify the charge nurse and other required team members, correct the medication process, and carry out any clinical follow-up ordered by policy.

## Explanation

Stop the unsafe process first, then verify identities, orders, and whether exposure occurred. Assess any potentially affected client, communicate through the facility's safety pathway, correct the immediate medication process, and report the near miss so the system can learn from it.

## In-depth explanation

Correct sequence
Stop → verify → assess → notify and correct → report and learn.

Why this is correct
A near miss is valuable safety information even when no drug reached the client. The nurse first prevents administration, determines whether exposure occurred, and assesses clinical risk. Event reporting then supports investigation and process improvement; it does not replace clinical communication or care.

NCLEX decision rule
Protect the client before completing the report. Record clinical assessment and care in the health record according to policy, and place system-learning details in the designated event-reporting pathway.References
1AHRQ PSNet: reporting patient safety eventsReviewed 2025
2AHRQ PSNet: investigating events and near misses

## Clinical scenario

Medication near miss
At the bedside, the barcode alert shows that the rapid-acting insulin pen and open MAR belong to a different client. The nurse has not injected the insulin. Follow immediate safety actions with reporting and systems learning.

## Key concepts

- **Near Miss** — A patient-safety event that could have caused harm but did not reach the patient or did not cause harm.
- **Event Report** — A designated safety-reporting record used to identify hazards and support organizational learning.
- **Rule of 15** — A common approach for mild to moderate hypoglycemia in an awake client.

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