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Difficulty: HardPharmacological Therapies

A practical nurse is assigned to care for a client who is receiving daily immunosuppressive therapy following a recent kidney transplant. The client has several scheduled interventions and medications for the morning shift. Which actions by the practical nurse demonstrate safe pharmacological practice and adherence to the legal scope of practice? Select all that apply.

  1. Verifying the client's name and date of birth against the medication administration record before providing oral anti-rejection medications.Answer
  2. Reinforcing the registered nurse's education about the importance of reporting any signs of infection, such as a sore throat or low-grade fever.Answer
  3. C
    Administering a scheduled live-attenuated influenza vaccine to protect the client from seasonal respiratory viruses.
  4. D
    Drawing up and administering an intravenous push dose of a prescribed antiemetic to treat the client's sudden onset of severe nausea.
  5. E
    Administering the scheduled morning dose of a nephrotoxic immunosuppressant drug despite noting a new, critically elevated serum creatinine level.
  6. Withholding a scheduled oral antihypertensive medication and notifying the registered nurse because the client's systolic blood pressure is 88 mm Hg.Answer

Answer

The correct actions include verifying the client's identity using two identifiers, reinforcing education regarding infection risks associated with immunosuppression, and withholding antihypertensive medications in the presence of hypotension.
The correct actions align with the practical nurse's legal scope and safe pharmacology principles. Verifying two unique identifiers ensures the right client receives the medication. Reinforcing previously delivered education about infection risks is a designated responsibility of the practical nurse, particularly vital for a client on immunosuppressants. Finally, recognizing a hypotensive state (systolic blood pressure of 88 mm Hg) and withholding an antihypertensive medication prevents dangerous hemodynamic instability, which is a critical safety intervention.

Step-by-Step Solution

1
Analyze the client scenario and clinical context.
The client is immunocompromised due to anti-rejection medications following a kidney transplant, meaning they are at high risk for infection and organ rejection.
Understanding the client's baseline vulnerabilities guides safe medication choices and education needs.
2
Evaluate each option against the practical nurse (PN) scope of practice.
Reinforcing teaching and withholding medications based on abnormal vital signs are within the PN scope. Administering IV push medications requires advanced assessment and is outside the standard PN scope.
Scope of practice dictates which pharmacological interventions a practical nurse can safely and legally perform.
3
Evaluate each option against pharmacological safety rules.
Using two identifiers is a mandatory safety standard. Giving live vaccines to an immunosuppressed client is dangerous. Administering nephrotoxic drugs in the presence of elevated creatinine without consulting a provider risks graft failure.
Medication safety requires checking contraindications (live vaccines) and pertinent laboratory data before administration.

Key Concept

Practical Nurse Scope of Practice and Immunosuppressant Therapy Safety
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Topics

Pharmacological Therapies

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