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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is reviewing the morning laboratory results for an adult client who is scheduled to receive a dose of subcutaneous enoxaparin. The client's most recent platelet count is 45,000/mm345,000/\text{mm}^3 (normal reference range: 150,000 to 400,000/mm3150,000 \text{ to } 400,000/\text{mm}^3). Which of the following is the most appropriate action for the PN to take?

  1. Withhold the scheduled medication and immediately notify the supervising registered nurse (RN) or healthcare provider.Answer
  2. B
    Administer the enoxaparin as scheduled, as it is a routine prophylactic treatment for deep vein thrombosis.
  3. C
    Independently decrease the medication dosage to minimize the risk of bleeding before administering.
  4. D
    Administer the dose after verbally confirming the client's name, omitting a second identifier to ensure timely delivery.

Answer

The most appropriate action is to withhold the scheduled dose of enoxaparin and promptly report the abnormal laboratory result to the registered nurse (RN) or healthcare provider.
The correct answer involves withholding the medication and notifying the supervising RN or healthcare provider. Enoxaparin is a low-molecular-weight heparin used as an anticoagulant. The client's platelet count is 45,000/mm345,000/\text{mm}^3, which indicates severe thrombocytopenia (normal is 150,000 to 400,000/mm3150,000 \text{ to } 400,000/\text{mm}^3). Administering an anticoagulant to a client with critically low platelets creates a severe risk for hemorrhage. A key responsibility within the practical nurse's scope of practice is to evaluate relevant laboratory data prior to medication administration, withhold medications when safety parameters are not met, and immediately report these critical findings.

Step-by-Step Solution

1
Identify the normal reference range for a platelet count.
The normal platelet count is 150,000 to 400,000/mm3150,000 \text{ to } 400,000/\text{mm}^3.
Comparing the client's laboratory results to the expected normal range is necessary to identify potential abnormalities before administering medications.
2
Evaluate the client's specific laboratory value.
The client's platelet count of 45,000/mm345,000/\text{mm}^3 is critically low, a condition known as thrombocytopenia.
Recognizing a critical laboratory value determines whether the scheduled pharmacological therapy is safe to administer or if it poses a risk to the client.
3
Determine the appropriate nursing intervention based on safety and the PN scope of practice.
The medication should be withheld and the abnormal finding escalated to the supervising RN.
Enoxaparin is an anticoagulant that can cause severe bleeding in a client with existing thrombocytopenia. It is within the PN's scope to withhold a contraindicated medication and report the critical finding.

Key Concept

Pre-administration safety checks and escalating critical laboratory values
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Topics

Pharmacological Therapies

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