Examkin

Question

Difficulty: HardPharmacological Therapies

A 5-year-old client is brought to a pediatric outpatient clinic for a follow-up appointment. The child is currently receiving high-dose oral prednisone therapy for a severe asthma exacerbation that began one week ago. The healthcare provider prescribes an intramuscular inactivated influenza vaccine (IIV), a subcutaneous measles, mumps, and rubella (MMR) vaccine, and an oral amoxicillin suspension for a newly diagnosed otitis media. Which intended actions by the practical nurse (PN) demonstrate safe pharmacological practice? Select all that apply.

  1. Administering the inactivated influenza vaccine (IIV) into the deltoid muscle as prescribed.Answer
  2. B
    Preparing to administer the scheduled MMR vaccine to ensure the child remains compliant with school entry requirements.
  3. C
    Instructing the caregiver to use a standard household spoon to measure the amoxicillin suspension if an oral syringe is misplaced.
  4. Reinforcing the provider's explicit instructions to taper the oral prednisone dose rather than abruptly discontinuing the medication.Answer
  5. E
    Dispensing the oral amoxicillin without verifying the child's identification band since the nurse recognizes the family from the waiting area.
  6. Withholding the initial dose of amoxicillin and notifying the provider after the caregiver reports the child developed hives from penicillin in the past.Answer

Answer

The correct actions include administering the inactivated influenza vaccine, reinforcing instructions to taper the prednisone, and withholding the amoxicillin if a penicillin allergy is reported.
Safe pharmacological practice requires the nurse to synthesize current client data, recognize contraindications, and strictly adhere to administration standards. Administering an inactivated vaccine is safe during corticosteroid therapy. Reinforcing the critical need to taper steroids prevents acute adrenal crisis and is firmly within the PN scope of practice. Furthermore, withholding a medication and notifying the provider upon discovering a relevant allergy (such as a penicillin allergy for an amoxicillin prescription) is an essential, life-saving intervention.

Step-by-Step Solution

1
Analyze the client's current medication profile and immune status.
The child is receiving high-dose oral prednisone, which causes systemic immunosuppression.
A client's current immune status dictates which pharmacological therapies, specifically vaccines, are safe to administer.
2
Evaluate the safety of the prescribed vaccines against the client's immunosuppressed state.
The inactivated influenza vaccine (IIV) is safe, but the live-attenuated MMR vaccine is strictly contraindicated.
Live vaccines can cause severe, unmanageable infections in immunocompromised individuals, whereas inactivated vaccines do not pose this risk.
3
Assess the PN's intended actions regarding medication administration principles and legal scope of practice.
Proper calibrated dosing tools must be utilized, two unique patient identifiers are legally required regardless of familiarity, and teaching reinforcement regarding corticosteroid tapering is mandatory.
Strict adherence to the core rights of medication administration and the defined LPN/LVN scope of practice prevents life-threatening sentinel events.

Key Concept

Pharmacological safety principles, including vaccine contraindications in immunosuppressed clients and strict adherence to medication administration rights.
Rate this question

Topics

Pharmacological Therapies

More questions from this topic