When initiating a controlled act, which of the following must an RN or RPN do?

• A. Assess the client and identify the problem
• B. Proceed directly with the chosen intervention
• C. Document only after the outcome is known
• D. Seek confirmation from a physician before acting

Answer: (A)

Starting any controlled act requires a careful assessment to determine what the patient needs and whether the action is appropriate and safe. This begins the nursing process: you gather data, identify the problem or need, and determine that the proposed intervention fits the patient’s condition and falls within your scope and any applicable protocols. Without this assessment, you wouldn’t have a justified reason for the intervention, and you could miss contraindications or risks.

That’s why identifying the problem through assessment is the best choice. It ensures the act is targeted to the actual issue, supports informed decision-making, and helps protect patient safety.

Proceeding directly with the intervention skips this essential step and could lead to unnecessary or harmful care. Documenting only after the outcome is known ignores the need for timely, accurate, and contemporaneous record-keeping. Seeking physician confirmation before acting is not universally required; many controlled acts can be initiated after a proper assessment and within established protocols or orders.