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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is providing care for a client who is admitted with heart failure and a respiratory infection. The client's prescriptions include oral furosemide, a weight-based dose of oral amoxicillin, and PRN intravenous (IV) push morphine for severe pain. Which of the following actions should the PN perform to ensure safe medication administration? Select all that apply.

  1. Verify the client's identity by comparing the medication administration record (MAR) to the client's wristband while asking them to state their name and date of birth.Answer
  2. B
    Administer the prescribed PRN IV push morphine when the client reports a pain level of 8 out of 10.
  3. C
    Rely solely on the registered nurse's (RN) verbal dosage calculation for the amoxicillin without independently verifying the math.
  4. Reinforce previous teaching with the client regarding the importance of consuming potassium-rich foods while taking furosemide.Answer
  5. E
    Bypass the barcode scanning process and use the client's room number for identification if the barcode scanner malfunctions.
  6. Withhold the furosemide and promptly report a critically low serum potassium laboratory result to the RN or provider.Answer

Answer

The correct actions include verifying the client's identity using the MAR and two acceptable identifiers, reinforcing teaching about potassium-rich foods for the prescribed furosemide, and withholding the diuretic while escalating a critically low potassium level to the RN.
Safe medication administration by a practical nurse involves adhering strictly to the medication rights, practicing within the defined legal scope, and applying clinical knowledge to prevent patient harm. Verifying the client using two acceptable identifiers (name and date of birth) ensures the medication is given to the correct person. Reinforcing teaching about dietary potassium is well within the PN scope and essential for clients taking a potassium-wasting loop diuretic like furosemide. Furthermore, recognizing a critically low potassium level as a direct contraindication for furosemide and escalating this finding to the RN demonstrates safe and required clinical judgment.

Step-by-Step Solution

1
Evaluate each action against the practical nurse (PN) scope of practice and medication safety principles.
Identify actions that are safe, legal, and appropriate for a PN to perform independently.
The NCLEX-PN requires an understanding of proper delegation, scope of practice boundaries, and adherence to the rights of medication administration.
2
Analyze the action of verifying identity using two identifiers (name and date of birth).
This is a correct action.
It fulfills the 'right client' medication right, which is a critical, non-negotiable safety standard.
3
Analyze the action of administering IV push morphine.
This is an incorrect action.
Administering IV push medications generally exceeds the PN scope of practice and must be performed by an RN.
4
Analyze the action of accepting verbal math calculations without independent verification.
This is an incorrect action.
Nurses must independently calculate and verify all medication dosages prior to administration to intercept potential math errors.
5
Analyze the action of reinforcing teaching about potassium-rich foods.
This is a correct action.
Reinforcing initial teaching provided by an RN is within the PN scope of practice, and furosemide is a potassium-wasting diuretic.
6
Analyze the action of using a room number for identification.
This is an incorrect action.
A room number is strictly prohibited as a patient identifier due to the high risk of error if a client is moved.
7
Analyze the action of withholding furosemide for a critically low potassium level and reporting to the RN.
This is a correct action.
Furosemide depletes potassium; giving it to a client with hypokalemia is highly dangerous. PNs must recognize critical labs, withhold contraindicated medications, and notify the RN immediately.

Key Concept

The practical nurse must adhere to their legal scope of practice—which includes administering scheduled oral medications, reinforcing teaching, and escalating abnormal findings—while strictly following the rights of medication administration.
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Topics

Pharmacological Therapies

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