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Difficulty: HardPharmacological Therapies

An older adult client with chronic obstructive pulmonary disease (COPD) and hypertension is admitted for a severe respiratory exacerbation. Current assessment findings include a blood pressure of 158/92 mmHg, a heart rate of 112 beats/min, a respiratory rate of 28 breaths/min, and an oxygen saturation of 88% on room air. The provider's orders include a one-time dose of intravenous (IV) push methylprednisolone, a stat albuterol nebulizer treatment, and a scheduled dose of oral amlodipine. Which of the following actions best demonstrates the appropriate role of the practical nurse (PN) in managing this client's pharmacological therapies?

  1. A
    Administer the oral amlodipine immediately to address the elevated blood pressure, relying solely on the client's verbal confirmation of their first name to expedite emergency care.
  2. B
    Withhold the albuterol nebulizer treatment due to the client's presenting heart rate of 112 beats/min and promptly document the rationale in the medical record.
  3. Initiate the albuterol nebulizer treatment, administer the oral amlodipine, and monitor the client's respiratory status while the registered nurse administers the intravenous push methylprednisolone.Answer
  4. D
    Prepare and administer the intravenous push methylprednisolone slowly over 3 to 5 minutes after confirming the client's identity using two distinct identifiers.

Answer

The practical nurse should safely administer the oral and inhaled medications, but must defer the administration of the intravenous push medication to the registered nurse.
The correct action demonstrates strict adherence to the practical nurse's legal scope of practice while appropriately prioritizing care. Administering oral and inhaled medications is safely within the practical nurse scope. However, intravenous push medications require the advanced assessment skills of a registered nurse. By initiating the respiratory treatment promptly, the practical nurse addresses the client's most critical airway needs while legally and safely delegating the intravenous medication.

Step-by-Step Solution

1
Analyze the client's clinical presentation and the prescribed pharmacological interventions.
The client is in a respiratory crisis (hypoxia, tachypnea) requiring immediate intervention with a bronchodilator (albuterol) and a corticosteroid (methylprednisolone), alongside management of hypertension (amlodipine).
Understanding the clinical priorities ensures that the most critical needs (Airway and Breathing) are addressed first.
2
Evaluate the practical nurse scope of practice regarding the prescribed medication routes.
Oral (amlodipine) and inhaled (albuterol) medication administration are within the practical nurse's scope of practice. However, intravenous push administration (methylprednisolone) is restricted and falls under the registered nurse's scope of practice.
Adhering strictly to the legal scope of practice is mandatory for client safety and professional licensure compliance.
3
Determine the safest and most effective plan for pharmacological management.
The practical nurse should initiate the albuterol nebulizer to address the immediate airway compromise, give the oral amlodipine, and collaborate with the registered nurse to administer the intravenous push methylprednisolone.
This collaborative approach ensures all medications are administered promptly while maintaining strict adherence to safety protocols and scope of practice limitations.

Key Concept

Practical Nurse Scope of Practice and Prioritization in Pharmacological Therapies
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Topics

Pharmacological Therapies

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