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Difficulty: HardPharmacological Therapies

The practical nurse (PN) is reviewing the morning assessment data and medication administration record (MAR) for a 6565-year-old client admitted with chronic kidney disease and hypertension.

Assessment DataCurrent Finding
Blood pressure142/88142/88 mmHg
Heart rate6464 beats/minute
Respiratory rate1818 breaths/minute
Oxygen saturation96%96\% on room air
Serum potassium5.95.9 mEq/L (5.95.9 mmol/L)

Scheduled Medications:
* Lisinopril 2020 mg PO daily
* Sodium polystyrene sulfonate 1515 g PO stat
* Metoprolol 55 mg IV push stat
* Influenza virus vaccine (inactivated) 0.50.5 mL IM once

Based on this data, which actions by the PN are appropriate? Select all that apply.

  1. Withhold the scheduled oral lisinopril and immediately report the hyperkalemia to the registered nurse (RN).Answer
  2. Administer the oral sodium polystyrene sulfonate after verifying the client's full name and date of birth.Answer
  3. Notify the charge nurse that the stat IV push metoprolol requires administration by an RN.Answer
  4. D
    Administer the stat IV push metoprolol slowly over 22 minutes while observing the client for hypotension.
  5. E
    Verify the client's identity using their room number and physical location before administering the influenza vaccine.
  6. F
    Withhold the influenza vaccine because the client reports experiencing a mild, localized rash at the injection site after last year's dose.

Answer

The practical nurse should withhold the oral lisinopril and notify the RN, safely administer the oral sodium polystyrene sulfonate using proper client identifiers, and notify the charge nurse that the IV push metoprolol requires RN administration.
The client's serum potassium level of 5.95.9 mEq/L indicates hyperkalemia. Because ACE inhibitors like lisinopril cause potassium retention, the scheduled dose must be withheld and the registered nurse (RN) notified to prevent cardiac complications. Administering oral sodium polystyrene sulfonate is an appropriate action to treat hyperkalemia, provided the PN verifies the client's identity using two client-specific identifiers (such as full name and date of birth). Furthermore, because administering medications via direct intravenous (IV) push typically exceeds the PN scope of practice, the PN must advocate for client safety by notifying the charge nurse that an RN is required to administer the IV metoprolol.

Step-by-Step Solution

1
Analyze the client's laboratory results in relation to the prescribed medications.
The serum potassium level is 5.95.9 mEq/L, indicating hyperkalemia. Lisinopril is an ACE inhibitor that can cause further potassium retention, whereas sodium polystyrene sulfonate is prescribed to lower potassium levels.
Identifying contraindications based on current laboratory data prevents potentially life-threatening adverse events.
2
Determine the legal boundaries of the practical nurse (PN) scope of practice.
The PN can safely administer oral (PO) and intramuscular (IM) medications, but administering intravenous (IV) push medications must be deferred to the RN.
Nurses must practice strictly within their legal scope to ensure safe, competent client care.
3
Evaluate the safety principles for medication identification and vaccine contraindications.
Safe administration requires two client-specific identifiers (excluding room numbers). Additionally, a mild localized reaction to a previous vaccine is not a valid contraindication for current administration.
Adhering strictly to medication safety rights and evidence-based immunization guidelines minimizes the risk of clinical errors.

Key Concept

Safe pharmacological therapy requires integrating client laboratory data to withhold contraindicated medications, adhering strictly to the PN scope of practice, and applying evidence-based medication safety standards.
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Pharmacological Therapies

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