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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is reviewing the medication administration record (MAR) and clinical data for four assigned clients. Which of the following medication administration tasks is safe and within the PN's scope of practice to perform?

  1. A
    Administering a scheduled dose of oral spironolactone to a client whose morning serum potassium level is 5.8 mEq/L.
  2. B
    Administering a one-time dose of intravenous (IV) push metoprolol to a client experiencing acute atrial fibrillation.
  3. Administering a scheduled subcutaneous injection of epoetin alfa to a client with chronic kidney disease whose hemoglobin is 9.8 g/dL.Answer
  4. D
    Administering a prescribed measles, mumps, and rubella (MMR) vaccine to a client who is 12 weeks pregnant.

Answer

The correct action is to administer the scheduled subcutaneous injection of epoetin alfa to the client with chronic kidney disease whose hemoglobin is 9.8 g/dL.
The administration of a subcutaneous injection is firmly within the practical nurse (PN) scope of practice. Furthermore, the clinical data supports the action: epoetin alfa is used to treat anemia associated with chronic kidney disease. The goal of therapy is to maintain hemoglobin levels between 10 and 11 g/dL. Because the client's hemoglobin is 9.8 g/dL, the medication is indicated and safe to administer. It would only be withheld if the level exceeded 11.0 g/dL due to the increased risk of thrombotic events.

Step-by-Step Solution

1
Evaluate each task against the practical nurse (PN) scope of practice constraints.
Intravenous (IV) push medications are generally outside the PN scope of practice, especially for acute conditions.
The NCLEX assumes standard PN scope, which excludes IV push and tasks requiring advanced clinical judgment.
2
Analyze the laboratory data provided for the remaining pharmacological interventions.
The client receiving spironolactone has hyperkalemia (5.8 mEq/L), which is a strict contraindication for a potassium-sparing diuretic.
Administering spironolactone would further increase potassium, risking fatal cardiac dysrhythmias.
3
Assess the immunization order against current health status contraindications.
The MMR vaccine is a live virus and is contraindicated for the client who is 12 weeks pregnant.
Live vaccines pose a severe teratogenic risk to the developing fetus.
4
Verify the safety and appropriateness of the epoetin alfa administration.
Subcutaneous administration is within PN scope, and a hemoglobin of 9.8 g/dL is an appropriate level to receive the medication.
Epoetin alfa is given to stimulate red blood cell production; it is only withheld when hemoglobin exceeds 11.0 g/dL due to cardiovascular risks.

Key Concept

Evaluating medication safety based on scope of practice, critical laboratory values, and absolute contraindications.
Estimated Time:1m 30s
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Topics

Pharmacological Therapies

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