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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is reviewing the medication administration record and preparing to care for several assigned clients. Which of the following actions by the PN demonstrate safe pharmacological practice and adhere to the practical nursing scope of practice? (Select all that apply.)

  1. Withholding a scheduled dose of oral diltiazem for a client with an apical pulse of 52 beats/minute and reporting the finding to the registered nurse (RN).Answer
  2. B
    Confirming client identity by stating the client's full name and waiting for verbal agreement before administering oral medications.
  3. C
    Administering a prescribed PRN dose of intravenous (IV) push ondansetron to a client experiencing severe postoperative nausea.
  4. Reinforcing teaching regarding the importance of maintaining a consistent dietary intake of vitamin K for a client prescribed warfarin.Answer
  5. E
    Administering a live attenuated influenza vaccine (LAIV) to a client who is currently receiving high-dose immunosuppressive chemotherapy.
  6. Documenting the administration of a scheduled subcutaneous enoxaparin injection immediately after safely disposing of the syringe.Answer

Answer

The correct actions include withholding diltiazem for bradycardia, reinforcing dietary teaching for warfarin, and documenting medication administration immediately after the procedure.
The correct actions demonstrate adherence to strict medication safety and professional scope. Withholding a calcium channel blocker for bradycardia prevents cardiovascular collapse. Reinforcing previous teaching regarding dietary vitamin K and warfarin ensures therapeutic anticoagulant levels without overstepping into initial RN teaching duties. Finally, immediate documentation prevents dangerous duplicate medication errors.

Step-by-Step Solution

1
Evaluate each action for basic medication safety principles.
Identify that withholding a heart-rate lowering drug for bradycardia, checking proper contraindications, and timely documentation are essential safety measures.
Client safety is the primary goal; failing to identify contraindications or abnormal vital signs before administration can lead to severe adverse events.
2
Analyze each action against the established practical nursing scope of practice.
Determine that reinforcing teaching and administering oral/subcutaneous medications are within scope, whereas administering IV push medications and initial complex teaching are out of scope.
Nurses must operate strictly within their legal and educational boundaries to ensure competent care delivery.
3
Synthesize the findings to select the statements that meet both safety standards and scope constraints.
Select the options involving holding diltiazem, reinforcing warfarin education, and prompt documentation.
These actions demonstrate a comprehensive understanding of both pharmacological principles and professional nursing boundaries.

Key Concept

Safe Medication Administration and PN Scope of Practice
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Topics

Pharmacological Therapies

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