# 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. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=495938&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question 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. ## Explanation Slurred speech with an unsteady gait, an unexplained missing fentanyl vial, and unexplained opioid-type respiratory depression require immediate follow-up. Use objective observations, protect clients first, and activate the facility reporting process. ## In-depth explanation Quick answer Highlight the impaired gait and speech, the unexplained missing fentanyl vial, and the client with new somnolence and 8 breaths per minute without a documented opioid. Together they create an immediate client-safety and diversion concern. Why this is correct Impaired coordination can make medication administration unsafe. A controlled substance that cannot be reconciled adds an objective diversion signal, while unexpected respiratory depression in a client raises concern for an unrecorded opioid exposure. The charge nurse protects clients by removing the nurse from care according to policy, assessing the affected client, securing evidence, and reporting through the designated chain rather than diagnosing or arguing with the colleague.[2] Easy analogy or mental picture Think of several dashboard warning lights appearing together: unsafe performance, an unreconciled drug, and client harm. A single light needs checking; linked lights require the system to stop and investigate. The picture organizes urgency but does not diagnose the nurse. Memory hook Observe, protect, reconcile, report. NCLEX decision rule When objective impairment, a controlled-substance discrepancy, or unexplained client sedation appears, think immediate safety response; check the client, assignment, medication record, and reporting policy before confronting or making assumptions. Why the other choices are wrong A witnessed count, asking for a double-check, using two identifiers, logging out, and returning from break are ordinary safety behaviors. A client receiving a documented oral analgesic with relief does not explain the missing vial or unexpected respiratory depression.References - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]NCSBN: Substance Use Disorder in NursingNational Council of State Boards of Nursing ## 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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