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Difficulty: MediumPharmacological Therapies

An older adult client with a history of asthma and atrial fibrillation is admitted to a medical unit. The health care provider prescribes several new daily medications. Which actions by the practical nurse demonstrate safe pharmacological management? Select all that apply.

  1. Verify the client's identity using their full name and date of birth before giving oral digoxin.Answer
  2. Withhold the prescribed oral propranolol and notify the registered nurse after assessing audible wheezing.Answer
  3. C
    Administer the scheduled dose of warfarin despite a morning international normalized ratio (INR) of 4.8.
  4. D
    Accept a verbal order during rounds to administer an intravenous push dose of metoprolol.
  5. E
    Confirm the client's room number and bed assignment as the second identifier when the barcode system is offline.
  6. Reinforce previous instructions to rinse the oral cavity with water after using a prescribed budesonide inhaler.Answer

Answer

The correct actions are to verify identity using the client's name and date of birth, withhold the propranolol due to active wheezing, and reinforce instructions to rinse the mouth after using the budesonide inhaler.
Safe pharmacological management encompasses strict adherence to the rights of medication administration, including using two acceptable client identifiers (like name and date of birth). Practical nurses must also recognize critical contraindications, such as the danger of administering a non-selective beta-blocker (propranolol) to an asthmatic client who is actively wheezing, as it can worsen bronchospasm. Finally, reinforcing prior teaching regarding self-care measures, such as rinsing the mouth after using an inhaled corticosteroid to prevent candidiasis, is an essential and appropriate component of the practical nurse's scope of practice.

Step-by-Step Solution

1
Evaluate each action against the standard rights of medication administration.
Using full name and date of birth is correct; using a room number is incorrect and violates safety protocols.
Two unique, client-specific identifiers are required to prevent medication errors.
2
Analyze the prescribed medications against the client's medical history and current assessment findings.
Propranolol must be withheld in an asthmatic client with audible wheezing.
Non-selective beta-blockers like propranolol can trigger severe bronchospasms in clients with a history of asthma.
3
Determine if the actions align with the practical nurse's scope of practice.
Reinforcing teaching about budesonide is within the scope; accepting and giving IV push medications is outside the scope. Additionally, administering warfarin with a critically high INR represents a failure to escalate critical data.
The PN must practice within legal boundaries, which excludes IV push administration and requires reporting abnormal physiological findings before proceeding.

Key Concept

Safe medication administration requires adherence to the rights of medication administration, understanding contraindications (such as beta-blockers in asthma), and functioning within the practical nurse scope of practice.
Estimated Time:1m 30s
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Pharmacological Therapies

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