# Before a medication pass, the charge nurse notices that a staff nurse has slurred speech, an unsteady gait, and an odor of alcohol. Which action should the charge nurse take first?

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: MOC

## Question

Before a medication pass, the charge nurse notices that a staff nurse has slurred speech, an unsteady gait, and an odor of alcohol. Which action should the charge nurse take first?

## Option

1. Remove the nurse from client care and follow the facility reporting process **✔ Correct answer**
2. Ask another nurse to observe the medication pass before deciding what to do
3. Send the nurse home after the assigned clients receive their scheduled medications
4. Discuss the observations privately at the end of the nurse's scheduled shift

**Correct answer: 1**

## Explanation

Observable impairment creates an immediate client-safety risk. The charge nurse should remove the nurse from practice, secure coverage, document objective observations, and follow the facility's reporting and fitness-for-duty process.

## In-depth explanation

Quick answer
Stop the impaired nurse's client-care duties now and activate the facility reporting process.

Why this is correct
Slurred speech, gait instability, and alcohol odor are objective signs that the nurse may be unsafe to practice. Protecting clients comes before investigating the cause; the designated supervisor and policy then guide evaluation, transport, documentation, and reporting.

Easy analogy or mental picture
This is like taking a visibly malfunctioning device out of service before troubleshooting it. The nurse is a person entitled to dignity and due process, so the analogy addresses immediate safety rather than guilt or diagnosis.

Memory hook
Impairment signs lead to remove, cover, document, and report.

NCLEX decision rule
When a clinician shows objective signs of impairment, first prevent further client contact. Use neutral observations and the established chain for fitness-for-duty evaluation instead of diagnosing, confronting, or delaying for additional proof.

Why the other choices are wrong
Observation during medication administration leaves clients exposed. Finishing medications delays risk control, and waiting until shift end postpones the required safety response.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]Washington State Board of Nursing: CARES Guide for Colleagues Concerned About Substance UseWashington State Board of Nursing, 2025

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