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Difficulty: HardPharmacological Therapies

A practical nurse (PN) preceptor is observing a newly hired PN provide care and administer medications to a group of clients. Which of the following actions by the newly hired PN indicate a breach of safety and require immediate intervention by the preceptor? Select all that apply.

  1. Administering a scheduled live attenuated measles, mumps, and rubella (MMR) vaccine to a client who is at 16 weeks16\text{ weeks} of gestation.Answer
  2. Administering an oral dose of metoprolol to a client whose current vital signs include a blood pressure of 86/52 mmHg86/52\text{ mmHg} and a heart rate of 115 beats/min115\text{ beats/min}.Answer
  3. Bypassing the electronic barcode scanner and relying on the client's room number for identification prior to giving oral hydrocodone.Answer
  4. Accepting an assignment to initiate and continuously titrate an intravenous (IV) nitroprusside infusion for a client in hypertensive crisis.Answer
  5. E
    Withholding a scheduled oral dose of warfarin and notifying the registered nurse (RN) when the client's morning international normalized ratio (INR) is 5.45.4.
  6. F
    Converting a pediatric client's body weight from pounds to kilograms before utilizing a formula to calculate a prescribed liquid amoxicillin dose.

Answer

The actions requiring immediate intervention are: administering a live vaccine during pregnancy, giving a beta-blocker to a hypotensive/tachycardic client, identifying a client by room number, and accepting a task to titrate a high-alert IV drip.
Intervention is required when a nurse operates outside their scope of practice (titrating IV vasoactive drips) or compromises client safety. Administering a live vaccine to a pregnant client risks fetal harm. Giving a beta-blocker to a client with early signs of shock (hypotension and tachycardia) can lead to cardiovascular collapse. Relying on a room number instead of two distinct identifiers violates the fundamental rights of medication administration.

Step-by-Step Solution

1
Analyze each action to determine if it aligns with safe pharmacological principles and the practical nurse (PN) scope of practice.
Identify that the MMR vaccine is live and contraindicated in pregnancy. Identify that giving metoprolol to a hypotensive and tachycardic client risks cardiovascular collapse. Identify that room numbers violate the fundamental rights of medication administration. Identify that titrating high-alert continuous IV drips is outside the PN scope.
Identifying unsafe practices is crucial to prevent adverse drug events and maintain professional boundaries.
2
Evaluate the remaining actions for appropriateness.
Identify that withholding warfarin for a critically high INR of 5.4 and converting pounds to kilograms for pediatric dosing are both safe, standard practices.
Appropriate actions reflect sound clinical judgment and do not require preceptor intervention.
3
Select all the actions that represent safety breaches or scope violations.
The four unsafe actions are selected.
The question specifically asks for actions requiring immediate intervention.

Key Concept

Safe Medication Administration and Scope of Practice
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Topics

Pharmacological Therapies

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