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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is assigned to a 28-year-old client who is 12 weeks pregnant and visiting the clinic for a routine prenatal check-up. The healthcare provider has prescribed a new daily dose of oral labetalol for gestational hypertension and ordered the live-attenuated intranasal influenza vaccine (LAIV). The registered nurse (RN) delegates the initial medication teaching for the labetalol to the PN and asks the PN to administer the vaccine. Which of the following actions is the most appropriate for the PN to take?

  1. A
    Accept the delegation to provide the initial medication teaching for the labetalol, provided that an educational pamphlet is given to the client to read.
  2. B
    Refuse the teaching delegation, but administer the prescribed vaccine immediately after verbally verifying only the client's first name.
  3. Decline the delegation to perform the initial teaching for labetalol, and alert the RN that the live-attenuated influenza vaccine is contraindicated for this pregnant client.Answer
  4. D
    Inform the RN that initial teaching is outside the PN scope of practice, but prepare and administer the live-attenuated influenza vaccine as prescribed.

Answer

The most appropriate action is to decline the delegation to perform the initial teaching for labetalol and alert the RN that the live-attenuated influenza vaccine is contraindicated for the pregnant client.
The safest and most legally sound approach requires the practical nurse (PN) to recognize two distinct issues. First, providing initial medication education requires a comprehensive assessment of the client's learning needs, which falls strictly within the registered nurse (RN) scope of practice; the PN may only reinforce teaching previously initiated by the RN. Second, live-attenuated vaccines, such as the intranasal influenza vaccine, are strictly contraindicated during pregnancy due to the theoretical risk of transmitting the live virus to the developing fetus. Therefore, the PN must decline the inappropriate delegation and escalate the contraindicated order.

Step-by-Step Solution

1
Evaluate the delegation of initial medication teaching for labetalol.
Initial education requires assessing the client's learning baseline and comprehension, which is exclusively an RN-level responsibility.
The PN scope of practice is legally limited to reinforcing education that has already been provided by the RN or provider.
2
Evaluate the prescription for the live-attenuated intranasal influenza vaccine (LAIV).
The client is 12 weeks pregnant.
Live-attenuated vaccines are strictly contraindicated during pregnancy because they pose a theoretical risk of transmitting the live virus to the developing fetus.
3
Determine the safest nursing action based on the findings.
The PN must decline the out-of-scope teaching task and inform the RN about the immunization contraindication.
Practicing within legal boundaries and actively advocating for client safety are fundamental nursing responsibilities.

Key Concept

LPN/VN Scope of Practice and Immunization Contraindications
Estimated Time:1m 30s
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Topics

Pharmacological Therapies

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