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Difficulty: MediumPharmacological Therapies

While providing care on a medical-surgical unit, a practical nurse manages medication administration and reinforces teaching for several assigned clients. Which of the following clinical actions demonstrate safe pharmacological practice? Select all that apply.

  1. Withholding a scheduled dose of levothyroxine and notifying the registered nurse for a client with a resting heart rate of 118 beats/minute.Answer
  2. B
    Administering a live-attenuated influenza vaccine to a client who is actively receiving immunosuppressive chemotherapy.
  3. Reinforcing the instruction to rinse the mouth with water and spit after using an inhaled fluticasone corticosteroid.Answer
  4. D
    Delivering a prescribed dose of intravenous push morphine to a client reporting sudden, severe surgical site pain.
  5. E
    Bypassing the electronic barcode medication scan to expedite the delivery of an urgent, first-dose antibiotic.
  6. Reminding a client prescribed sublingual nitroglycerin to keep the tablets stored in their original, dark glass container.Answer

Answer

The correct actions include withholding levothyroxine for significant tachycardia, reinforcing the need to rinse the mouth after inhaled corticosteroids, and instructing clients to keep nitroglycerin in its original dark container.
Safe pharmacological practice requires the practical nurse to understand medication actions, side effects, and strict adherence to scope of practice. Levothyroxine increases the metabolic rate; a resting heart rate of 118 beats/minute indicates potential toxicity, requiring the nurse to withhold the dose and notify the registered nurse. Inhaled corticosteroids like fluticasone can cause oral candidiasis, so reinforcing the need to rinse the mouth helps prevent local infection. Nitroglycerin tablets degrade rapidly when exposed to light or moisture, making it essential to reinforce storing them in their original light-resistant container.

Step-by-Step Solution

1
Evaluate each clinical action against established medication safety protocols and the practical nurse scope of practice.
Actions involving withholding medication for adverse clinical signs, reinforcing proper medication storage, and teaching side-effect prevention are identified as safe and within the designated scope.
The practical nurse must consistently recognize clinical red flags, provide accurate client education reinforcement, and operate strictly within legal and professional boundaries.
2
Identify actions that violate fundamental safety standards or exceed the practical nursing scope of practice.
Administering IV push opioids, giving live vaccines to immunosuppressed clients, and bypassing safety barcode scans are identified as unsafe or out of scope.
These specific actions compromise patient safety by increasing the risk of adverse reactions, severe infections, and medication administration errors.

Key Concept

Safe Medication Administration and Scope of Practice
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Topics

Pharmacological Therapies

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