A practical nurse (PN) is assigned to care for a 68-year-old client with chronic obstructi… — NCLEX-PN

A practical nurse (PN) is assigned to care for a $68$ -year-old client with chronic obstructive pulmonary disease (COPD). The PN is reviewing the client's morning data prior to administering the scheduled 0900 medications.

Current Data:
- Vital signs: Blood pressure $138/84\text{ mmHg}$ , Heart rate $118\text{ beats/min}$ , Respiratory rate $22\text{ breaths/min}$ .
- Laboratory results: Serum theophylline level $24\text{ mcg/mL}$ , Fasting blood glucose $165\text{ mg/dL}$ .
- Scheduled 0900 medications: Oral theophylline, oral prednisone, and inhaled albuterol.

Based on the data provided, which of the following actions by the PN demonstrate safe and appropriate pharmacological management? (Select all that apply.)

Withhold the scheduled oral theophylline and immediately notify the registered nurse (RN) of the laboratory results.Answer
Reinforce education with the client to strictly avoid consuming caffeinated beverages while receiving theophylline therapy.Answer
Proceed with administering the oral prednisone, recognizing that the elevated blood glucose is a known effect of corticosteroid therapy.Answer
D
Administer the oral theophylline as prescribed because the serum drug level is within the normal therapeutic range.
E
Accept a delegation from the RN to administer a prescribed intravenous (IV) push beta-blocker to treat the client's tachycardia.
F
Assume the heart rate of $118\text{ beats/min}$ is a baseline finding for COPD and administer all medications without further escalation.

Answer

The correct actions are to withhold the theophylline and notify the RN, reinforce teaching to avoid caffeine, and proceed with the administration of prednisone.

Theophylline has a narrow therapeutic range of

10

20\text{ mcg/mL}

. The client's level of

24\text{ mcg/mL}

accompanied by tachycardia (

118\text{ beats/min}

) clearly indicates toxicity. The PN must withhold the medication, notify the RN, and reinforce teaching to avoid methylxanthine-containing substances like caffeine, which exacerbate toxicity. Conversely, an elevated blood glucose level is an expected side effect of the corticosteroid prednisone and is not a reason to withhold the dose.

Step-by-Step Solution

Evaluate the client's theophylline laboratory result.

The theophylline level is

24\text{ mcg/mL}

, which exceeds the narrow therapeutic range of

10

20\text{ mcg/mL}

Recognizing a toxic drug level is required to prevent the administration of further doses that could cause fatal arrhythmias or seizures.

Assess the vital signs in relation to the pharmacological therapies.

The client has a heart rate of

118\text{ beats/min}

, which is an active clinical manifestation of theophylline toxicity.

Correlating vital signs with drug levels confirms the presence of toxicity and underscores the urgency of withholding the medication and notifying the RN.

Evaluate the client's blood glucose level in relation to the prescribed prednisone.

The fasting blood glucose is elevated at

165\text{ mg/dL}

, which is an expected, drug-induced effect of corticosteroid therapy.

Understanding expected adverse effects ensures that essential maintenance therapies (like steroids for COPD) are not inappropriately withheld.

Determine appropriate PN actions based on legal boundaries and safety protocols.

The PN must reinforce teaching about interacting substances like caffeine and refuse tasks outside their scope, such as administering IV push medications.

Safe pharmacological management requires strict adherence to the practical nurse's legal scope of practice.

Key Concept

Synthesizing narrow-therapeutic-index drug toxicity, expected medication side effects, and practical nurse scope of practice limitations.

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