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Difficulty: MediumPharmacological Therapies

A client admitted with a deep vein thrombosis is prescribed a daily dose of subcutaneous enoxaparin. Prior to administering the medication, the practical nurse (PN) reviews the client's morning laboratory results and notes a platelet count of 80,000 cells/mm380,000\text{ cells/mm}^3 (normal: 150,000−400,000 cells/mm3150,000 - 400,000\text{ cells/mm}^3). Which action should the PN take?

  1. Withhold the medication and immediately report the platelet count to the supervising registered nurse (RN).Answer
  2. B
    Administer the medication as prescribed and continue to monitor the client for signs of bleeding.
  3. C
    Calculate a lower weight-based dose of the medication to reduce the risk of adverse bleeding effects.
  4. D
    Administer the medication via intravenous (IV) push to prevent localized tissue bruising at the injection site.

Answer

The correct action is to withhold the scheduled enoxaparin and immediately report the abnormal laboratory findings to the supervising registered nurse.
Enoxaparin is a low-molecular-weight heparin used to prevent or treat clot formation. A platelet count of 80,000 cells/mm380,000\text{ cells/mm}^3 indicates thrombocytopenia, which places the client at a high risk for spontaneous and potentially severe bleeding. Administering an anticoagulant under these conditions is clinically unsafe. The practical nurse's priority, acting within their defined scope of practice, is to withhold the medication and immediately notify the registered nurse (RN) or healthcare provider so the therapy can be safely re-evaluated.

Step-by-Step Solution

1
Analyze the client's laboratory results in the context of the prescribed medication.
The platelet count of 80,000 cells/mm³ is significantly below the normal range, indicating thrombocytopenia.
Safe medication administration requires correlating current laboratory values with the intended pharmacological therapy.
2
Determine the safety and contraindications of administering the drug.
Enoxaparin is an anticoagulant; administering it to a client with pre-existing low platelets severely increases the risk of life-threatening hemorrhage.
Anticoagulants prevent clot formation, and platelets are essential for blood clotting. A deficiency in platelets contraindicates anticoagulant use.
3
Identify the appropriate nursing action within the PN scope of practice.
The PN must withhold the dose and escalate the critical finding to the RN or primary healthcare provider.
The PN is responsible for recognizing critical abnormalities and communicating them to the supervising RN for further clinical decision-making.

Key Concept

Pharmacological safety and PN scope of practice regarding critical laboratory values
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Topics

Pharmacological Therapies

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