# Review the 4-day trend after a medication error and answer the three questions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568344&lang=en  
> language: en  
> subject: Assignment/Delegation/Supervision  
> category: MOC

## Question

Review the 4-day trend after a medication error and answer the three questions.

| Time | Data |
| --- | --- |
| Day 1 | data: Patient in ICU; family not yet notified; night RN on administrative leave; no RCA scheduled. |
| Day 2 | data: Family meeting held; error disclosed; patient stable; night RN meets EAP; no RCA scheduled. |
| Day 3 | data: Patient discharged; RCA team formed; first meeting set for Day 6; night RN returns with preceptor. |
| Day 4 | data: RCA interviews conducted; preliminary findings: abbreviation, no double-check, CPOE lacks hard stops; action plan due Day 45. |

Q1. How should the overall response be evaluated through Day 4?

Ineffective — disclosure was withheld and the night RN was punished without a system review.
Fully effective — all phases of the response were timely and complete.
Partially effective — the night RN returned to work too soon, undermining staff safety.
Partially effective — family disclosure and second-victim support occurred, but RCA was delayed until Day 6.

Q2. Which action should be prioritized in the final action plan?

Expand independent double-checks to all medications, not just high-alert ones.
Implement independent double-checks only, and defer CPOE changes for 90 days.
Implement CPOE hard stops for insulin and require independent double-checks for all high-alert medications.
Implement CPOE hard stops only, and defer double-check decisions for 90 days.

Q3. What is the most appropriate monitoring plan for the action plan?

Rely on staff self-reporting without formal audits.
Audit CPOE compliance, abbreviation reduction, and double-check completion at 90, 180, and 365 days.
Audit only CPOE compliance at 90 days, then close the case.
Audit double-check completion at 30 days, then decide on further monitoring.

## Explanation

The trend shows a response that is partially effective: disclosure and second-victim support occurred promptly, but the RCA was not convened until Day 6, delaying system analysis. The action plan must prioritize CPOE hard stops and independent double-checks for high-alert medications, with effectiveness monitoring at 90, 180, and 365 days.

## In-depth explanation

Quick answer
Partially effective — family disclosure and second-victim support occurred, but RCA was delayed until Day 6.

Why this is correct
The response addressed the patient and the nurse promptly, but the system-level analysis (RCA) was not initiated until Day 6, leaving a gap in early system learning.

Clinical picture
In a just culture, immediate priorities are patient care, family disclosure, and staff support. The RCA should be convened as soon as feasible, typically within 24-72 hours, to capture details and begin system fixes.

Memory hook
RCA timing is a key indicator of organizational safety maturity. Delays beyond 72 hours are considered a weakness in the response.

NCLEX decision rule
Evaluate the response phase by phase: patient/family, staff, system. A delay in any phase reduces overall effectiveness.

Why the alternatives are wrong
Ineffective — disclosure was withheld: Incorrect; disclosure occurred on Day 2. Fully effective — all phases timely: Incorrect; RCA was delayed. Ineffective — night RN punished without RCA: Incorrect; RCA was formed, though late, and the nurse received support.

Sources
1NCSBN 2026 NCLEX-RN Test Plan
2AHRQ RCA2

## Clinical scenario

A nurse gave a patient 10 times the ordered insulin dose. The patient recovered after treatment. The hospital's response is tracked over four days.

## Key concepts

- **Root cause analysis (RCA)** — A structured method to identify underlying system causes of an error and develop corrective actions.
- **Second-victim support** — Emotional and professional support for healthcare providers involved in an adverse event.
- **Just culture** — An organizational approach that balances accountability and learning, focusing on system flaws rather than individual blame.

## 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. W…](https://mymerci.kr/pages/nclex_q.php?qn_id=360523&lang=en)
- [A 78-year-old male client with end-stage pancreatic cancer is enrolled in inpatient hospic…](https://mymerci.kr/pages/nclex_q.php?qn_id=362322&lang=en)
- [A nurse on a medical-surgical unit is starting a 0700 round and reviews these four assigne…](https://mymerci.kr/pages/nclex_q.php?qn_id=362403&lang=en)
- [An RN is assigning care on a medical-surgical unit to an LPN/VN and a trained unlicensed a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362464&lang=en)
- [A registered nurse on a medical-surgical unit is assigning tasks to a licensed practical n…](https://mymerci.kr/pages/nclex_q.php?qn_id=363932&lang=en)
- [A charge nurse on a medical-surgical unit is making assignments for the day shift. The tea…](https://mymerci.kr/pages/nclex_q.php?qn_id=363953&lang=en)
- [A nurse manager is reviewing situations from the past week to identify potential HIPAA Pri…](https://mymerci.kr/pages/nclex_q.php?qn_id=364050&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=568344&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=568344&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=568344&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=568344&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=568344&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._