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Difficulty: HardPharmacological Therapies

An older adult client with a history of type 2 diabetes mellitus and hypertension is admitted to a medical-surgical unit for an acute exacerbation of osteoarthritis. The morning medication profile includes oral metformin, oral lisinopril, oral meloxicam, and a new prescription for oral prednisone 40 mg40\text{ mg}. The unit pharmacy dispenses prednisone as 20 mg20\text{ mg} scored tablets. Which actions should the practical nurse (PN) take to safely administer and monitor these pharmacological therapies? Select all that apply.

  1. Administer the meloxicam and the prednisone during or immediately following the client's morning meal.Answer
  2. Monitor the client's capillary blood glucose levels more frequently during the shift.Answer
  3. Review the client's most recent serum creatinine and blood urea nitrogen (BUN) laboratory results prior to administration.Answer
  4. D
    Administer four tablets of the dispensed prednisone to deliver the prescribed morning dose.
  5. E
    Verify the client's identity using their first name and the room number assigned to them on the unit.
  6. F
    Independently create and initiate a comprehensive teaching plan regarding the adverse effects of long-term corticosteroid therapy.

Answer

The correct actions include administering the meloxicam and prednisone with food, monitoring blood glucose more frequently, and reviewing renal laboratory results.
Safe pharmacological management for this client requires addressing multiple overlapping risks. Meloxicam (an NSAID) and prednisone (a corticosteroid) are highly irritating to the gastric mucosa, so administering them with food is essential to prevent ulceration. Prednisone induces gluconeogenesis and insulin resistance, necessitating increased blood glucose monitoring in a client with pre-existing type 2 diabetes. Finally, metformin, lisinopril, and meloxicam all pose risks to or are dependent on renal function, making it critical to verify baseline serum creatinine and blood urea nitrogen (BUN) before administration.

Step-by-Step Solution

1
Analyze the prescribed medication profile against the client's medical history.
The client has diabetes and is receiving prednisone (increases glucose); the client is receiving meloxicam and prednisone (both cause GI upset); the client is receiving metformin, lisinopril, and meloxicam (all require renal monitoring).
Identifying drug-disease and drug-drug interactions is a critical component of pre-administration safety checks.
2
Evaluate the required dose for the new prednisone prescription.
The prescribed dose is 40 mg40\text{ mg}. The available supply is 20 mg20\text{ mg} per tablet. Calculation: 40÷20=240 \div 20 = 2 tablets.
Accurate dosage calculation prevents medication administration errors.
3
Determine the appropriate scope of practice and safety protocols for the PN.
The PN must use two acceptable identifiers (not a room number) and can reinforce teaching but cannot independently create an initial teaching plan.
Adhering to safety standards and the PN scope of practice ensures legal and ethical care delivery.

Key Concept

Safe administration of complex pharmacological regimens requires verifying dosages, adhering to the rights of medication administration, anticipating adverse effects based on client comorbidities, and operating within the PN scope of practice.
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Topics

Pharmacological Therapies

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