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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is assigned to care for a client who is receiving a continuous intravenous (IV) heparin infusion for a deep vein thrombosis. The primary health care provider prescribes a new order for oral warfarin. Which action regarding medication administration is appropriate for the PN to perform?

  1. Administer the prescribed oral warfarin after matching the client's stated name and date of birth to the medication administration record.Answer
  2. B
    Titrate the continuous IV heparin infusion rate according to the facility's standardized weight-based protocol.
  3. C
    Identify the client by asking them to confirm their room and bed number before dispensing the oral warfarin.
  4. D
    Administer the oral warfarin after noting an international normalized ratio (INR) of 5.5 in the electronic health record without notifying the registered nurse.

Answer

The practical nurse should safely administer the oral warfarin by verifying the client's identity using their name and date of birth.
Administering oral medications is within the practical nurse's scope of practice. Using two distinct client identifiers, such as the stated name and date of birth matched to the medication administration record, represents the fundamental standard for safe medication administration.

Step-by-Step Solution

1
Determine the scope of practice for the practical nurse regarding the prescribed medications.
The PN can administer routine oral medications like warfarin, but titrating high-alert continuous IV infusions like heparin is restricted to the RN.
Adhering to the established scope of practice ensures client safety and legal compliance.
2
Review the requirements for safe medication administration.
The PN must use two acceptable client identifiers, such as name and date of birth, before administering any drug.
Using proper unique identifiers prevents medication administration errors.
3
Evaluate the laboratory values related to the medication.
Critically elevated values, such as an INR of 5.5, must be recognized and reported prior to giving a medication that further increases bleeding risk.
Failing to report critical labs and withholding contraindicated medications can lead to severe adverse events like hemorrhage.

Key Concept

Safe Medication Administration and Scope of Practice
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Topics

Pharmacological Therapies

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