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Difficulty: MediumPharmacological Therapies

At the beginning of the day shift, the practical nurse (PN) assumes care for a 58-year-old client admitted with hypertension and type 2 diabetes mellitus. The provider's orders include an intravenous (IV) push dose of furosemide, oral metoprolol, and subcutaneous regular insulin. Current morning assessment reveals a blood pressure of 138/82 mmHg138/82\text{ mmHg} and a capillary blood glucose of 185 mg/dL185\text{ mg/dL}. Which of the following actions by the PN are appropriate? Select all that apply.

  1. Verify the client's name and date of birth against the medication administration record.Answer
  2. Assess the client's apical pulse rate prior to administering the metoprolol.Answer
  3. Rotate the injection site for the subcutaneous regular insulin administration.Answer
  4. D
    Administer the prescribed intravenous (IV) push furosemide over 2 minutes.
  5. E
    Scan the medication barcodes into the electronic health record after the client swallows the pills.

Answer

The appropriate actions are to verify the client's name and date of birth, assess the apical pulse before giving metoprolol, and rotate the insulin injection site.
Safe pharmacological therapy requires the practical nurse to operate within their defined scope of practice while strictly adhering to safety protocols. This includes verifying at least two client identifiers, assessing vital parameters such as the apical pulse before administering beta-blockers, and utilizing proper administration techniques like rotating subcutaneous injection sites.

Step-by-Step Solution

1
Analyze the client's prescribed medications in the context of the practical nurse (PN) scope of practice.
The PN can safely administer the oral metoprolol and subcutaneous insulin, but the IV push furosemide requires a registered nurse.
Identifying tasks that fall outside the PN scope prevents unsafe practice and inappropriate task acceptance.
2
Evaluate each planned action for adherence to the rights of medication administration.
Verifying two client identifiers before administration is correct, but scanning barcodes after the client swallows the pills bypasses a critical pre-administration safety check.
Following strict medication administration rights reduces the risk of adverse errors.
3
Determine the necessary pre-administration clinical assessments and techniques for the specific medications.
Checking the apical pulse is necessary before giving a beta-blocker, and rotating sites is necessary for insulin.
Medication-specific assessments and techniques ensure therapeutic safety and efficacy.

Key Concept

Safe Medication Administration and Scope of Practice
Estimated Time:1m 30s
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Topics

Pharmacological Therapies

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