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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is preparing to administer morning medications to a client who is 2 days postoperative following a bowel resection. The client is receiving continuous intravenous (IV) fluids.

Current client data:

Assessment ParameterClient Result
Apical pulse54 beats/min
Blood pressure118/76 mm Hg
Respiratory rate16 breaths/min
Platelet count45,000/mm345,000/\text{mm}^3
Pain scale (0-10)6

Which of the following medication administration actions by the PN are appropriate? (Select all that apply.)

  1. Withhold the scheduled oral metoprolol and notify the registered nurse (RN) regarding the client's heart rate.Answer
  2. B
    Administer a prescribed intravenous (IV) push dose of hydromorphone to address the client's reported pain.
  3. C
    Administer the scheduled subcutaneous enoxaparin to prevent postoperative deep vein thrombosis.
  4. Administer the scheduled oral docusate sodium after verifying the client's name and date of birth on the identification band.Answer
  5. E
    Administer the prescribed oral acetaminophen by scanning the medication barcode and verbally confirming only the client's first name.
  6. Reinforce the registered nurse's previous education regarding the expected side effects of the prescribed analgesic therapies.Answer

Answer

The appropriate actions are to withhold the metoprolol due to bradycardia, administer the docusate after checking two distinct identifiers, and reinforce previous medication education.
The correct actions align with the practical nurse scope of practice and safe medication administration principles. Withholding the beta-blocker is clinically necessary because the client is bradycardic. Verifying the client's name and date of birth on the identification band fulfills the strict requirement for two unique identifiers. Finally, reinforcing prior education provided by the RN is a fundamental responsibility of the practical nurse.

Step-by-Step Solution

1
Evaluate the client's vital signs against the scheduled medications.
The apical pulse is 54 beats/min.
Beta-blockers like metoprolol decrease heart rate and are typically withheld if the pulse is less than 60 beats/min.
2
Evaluate the client's laboratory data against the scheduled medications.
The platelet count is critically low at 45,000/mm345,000/\text{mm}^3.
Anticoagulants (such as enoxaparin) are contraindicated with severe thrombocytopenia due to the extreme risk of hemorrhage.
3
Determine which medication administration tasks are within the practical nurse scope of practice.
Oral medication administration and teaching reinforcement are permitted, while IV push administration is generally not.
The PN must practice safely within legal and procedural boundaries, escalating advanced tasks like IV push to the RN.
4
Verify the correct procedure for client identification prior to administration.
Two distinct identifiers must be used (e.g., full name and date of birth).
Using only a first name risks administration errors; strict adherence to the rights of medication administration is required.

Key Concept

Safe medication administration, including evaluating clinical data, adhering to the scope of practice, and applying the rights of medication administration.
Estimated Time:2m 0s
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Topics

Pharmacological Therapies

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