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Difficulty: MediumPharmacological Therapies

During a shift on a medical-surgical unit, a provider prescribes 'Regular insulin 8 units intravenous (IV) push immediately' for a client experiencing severe hyperglycemia. The available medication vial is labeled 'Regular insulin 100 units/mL'. What is the most appropriate action for the practical nurse to take?

  1. Decline the task and notify the registered nurse that administering IV push medications exceeds the practical nurse scope of practice.Answer
  2. B
    Prepare 8 units of the medication and administer it directly into the client's continuous IV infusion port.
  3. C
    Calculate the required volume as 0.8 mL of regular insulin and prepare it for immediate intravenous administration.
  4. D
    Give the 8 units of regular insulin via the subcutaneous route to provide a legally permitted method of delivery.

Answer

The practical nurse should decline the task and notify the registered nurse that administering IV push medications exceeds their scope of practice.
The correct action is to decline the task and hand it over to the registered nurse. According to standard national nursing regulations, administering medications via the intravenous (IV) push route is strictly outside the scope of practice for a practical nurse (PN/LVN). This rule is especially critical for high-alert medications like insulin, which can cause rapid, life-threatening changes in the client's condition. The PN must recognize this limitation to maintain client safety and legal compliance.

Step-by-Step Solution

1
Analyze the prescribed medication and the requested route of administration.
The provider has ordered 8 units of regular insulin to be given via intravenous (IV) push.
Identifying the specific medication and route is the first step in ensuring safe medication administration.
2
Evaluate the requested task against the legal scope of practice for a practical nurse (PN/LVN).
Administration of IV push medications is restricted to registered nurses (RNs) and providers.
National nursing standards prohibit practical nurses from administering IV push medications due to the rapid onset of action and the advanced clinical judgment required.
3
Determine the safest and most legally compliant action.
The nurse must safely decline the order and immediately escalate the task to the registered nurse.
Protecting the client from unsafe practices and adhering to licensure limitations is the primary responsibility of the nurse.

Key Concept

Practical Nurse Scope of Practice regarding Intravenous Medications
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Topics

Pharmacological Therapies

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