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Difficulty: HardPharmacological Therapies

The clinical educator is evaluating a practical nurse (PN) during a medication administration pass on a step-down telemetry unit. The PN is managing multiple clients with complex medication regimens. Which of the following observed actions indicate that the PN is practicing safely and within the legal scope of practice? Select all that apply.

  1. The PN checks the apical pulse of a client prescribed oral digoxin and, noting a rate of 54 beats per minute54\text{ beats per minute}, holds the medication and alerts the charge nurse.Answer
  2. The PN tells a client receiving atorvastatin to immediately report any unexplained muscle tenderness or weakness before taking the next dose.Answer
  3. The PN asks a registered nurse to independently verify a weight-based dosage calculation for a pediatric client's oral antibiotic suspension.Answer
  4. D
    The PN responds to a client's sudden 10/1010/10 incisional pain by administering a PRN order of intravenous (IV) push hydromorphone.
  5. E
    The PN hands a client their morning oral medications and then scans the barcode on the client's wristband as the client swallows the pills.
  6. F
    The PN views a morning chemistry panel showing a potassium level of 2.9 mEq/L2.9\text{ mEq/L} (2.9 mmol/L2.9\text{ mmol/L}) and proceeds to administer the client's scheduled dose of oral furosemide.

Answer

The correct actions indicating safe practice include holding digoxin for a bradycardic pulse, reinforcing teaching about atorvastatin adverse effects, and asking a registered nurse to verify a weight-based pediatric medication calculation.
The correct actions demonstrate safe pharmacological care within the practical nurse's legal boundaries. Assessing an apical pulse and withholding digoxin for a heart rate below 60 beats per minute prevents potential toxicity and symptomatic bradycardia. Practical nurses are responsible for reinforcing client education, making the instruction about statin-induced myopathy appropriate. Furthermore, having an independent double-check for weight-based pediatric calculations is a standard safety protocol to prevent critical dosage errors.

Step-by-Step Solution

1
Analyze the role of the practical nurse regarding medication administration and client safety.
The PN must administer medications safely, recognize abnormal physiological findings, escalate critical issues, and stay strictly within their designated scope of practice.
Scope of practice guidelines and legal regulations dictate the boundaries of safe care for the PN.
2
Evaluate the options describing medication administration and pre-assessment monitoring.
Withholding digoxin for a pulse of 54 bpm is correct because the pulse is below the safe threshold of 60 bpm. Administering furosemide with a critically low potassium level of 2.9 mEq/L is a dangerous error.
The PN is responsible for checking pre-administration vital signs and recognizing critical laboratory values that contraindicate a medication.
3
Evaluate the options regarding the scope of practice limits (teaching, IV administration, verification).
Reinforcing teaching and asking for calculation double-checks are within scope. However, administering IV push hydromorphone is outside the PN's scope.
IV push medications and initial client education require RN-level advanced assessment and clinical judgment.
4
Evaluate the option regarding medication administration safety rights.
Scanning the barcode after administration is an incorrect and unsafe practice.
Scanning must occur immediately prior to administration to ensure the right patient receives the right medication, preventing fatal errors.

Key Concept

Practical Nursing Scope of Practice in Pharmacological Therapies
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Topics

Pharmacological Therapies

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