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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is assisting a registered nurse (RN) in caring for a client who reports sudden, severe chest pain. The healthcare provider issues a verbal order for "nitroglycerin 0.4 mg sublingually immediately and morphine sulfate 2 mg IV push." The RN prepares both medications, hands the morphine syringe to the PN, and states, "Give this IV push while I give the nitroglycerin." Which of the following is the most appropriate action by the PN?

  1. Decline to administer the IV morphine and offer to administer the sublingual nitroglycerin instead.Answer
  2. B
    Administer the IV morphine over 2 to 3 minutes while continuously monitoring the client's respiratory status.
  3. C
    Accept the syringe and administer the morphine immediately, bypassing the barcode scan due to the emergency.
  4. D
    Withhold both medications and assess the client's precise pain level on a 0 to 10 scale before proceeding.

Answer

The correct action is to decline the administration of the IV push medication and offer to perform a task within the PN scope of practice, such as administering the sublingual medication.
Intravenous (IV) push medication administration is strictly outside the scope of practice for a practical nurse (PN). Even in a life-threatening emergency, the PN must not accept tasks requiring RN-level judgment and skills. However, administering sublingual medications is well within the PN's scope. Declining the out-of-scope task while offering to perform the in-scope task ensures the client receives timely, safe care without violating the Nurse Practice Act.

Step-by-Step Solution

1
Identify the requested task and route of administration.
The RN is delegating the administration of an IV push medication (morphine sulfate) to the PN.
Understanding the precise nature of the assigned task is required to evaluate if it falls within the legal scope of practice.
2
Evaluate the delegated task against the PN scope of practice.
IV push medication administration requires RN-level assessment and judgment, and is strictly outside the PN scope of practice.
Patient safety and legal boundaries must be maintained at all times; emergencies do not legally expand a nurse's scope of practice.
3
Determine the appropriate collaborative action to ensure timely patient care.
The PN must decline the out-of-scope task but can offer to administer the sublingual nitroglycerin, which is an allowable route.
This ensures the client receives prompt, safe care while maintaining professional boundaries and legal safety.

Key Concept

LPN/LVN Scope of Practice in Emergent Medication Administration
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Topics

Pharmacological Therapies

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