For Unexpected Findings, the first action should be to

• A. Ignore findings
• B. Document findings
• C. Notify family
• D. Identify relevant assessment findings

Answer: (D)

When unexpected findings occur, the first action is to identify relevant assessment findings: determine what is abnormal, how it fits with the patient’s current condition, and what potential implications it has for safety and care. This step establishes a clear understanding of what changed and what it means, guiding all subsequent actions. After you’ve identified what’s relevant, you document the findings to create an accurate record, and then notify the appropriate team or family as dictated by policy. Ignoring findings jeopardizes safety, and notifying the family is important but not the initial step once you’ve established what the finding is and its significance.