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Difficulty: Very hardPharmacological Therapies

A practical nurse (PN) is caring for a 72-year-old client admitted with an acute exacerbation of heart failure and a suspected lower respiratory tract infection. The client's current vital signs are: temperature 102.4°F (39.1°C), heart rate 108 bpm, respiratory rate 26 breaths/min, and blood pressure 110/70 mm Hg. The client's admission weight is documented as 75 kg. The provider's prescriptions include oral digoxin, intravenous push bumetanide, a weight-based dose of oral amoxicillin, and an influenza immunization. Which of the following actions should the PN take? Select all that apply.

  1. A
    Administer the influenza immunization as prescribed to provide immediate prophylactic protection against viral pathogens.
  2. B
    Administer the bumetanide via direct intravenous push over two minutes to rapidly address the exacerbation of heart failure.
  3. Review the client's most recent serum potassium level prior to administering the scheduled dose of oral digoxin.Answer
  4. D
    Utilize the barcode scanner as the sole method of client identification to minimize exertion for the dyspneic client.
  5. E
    Determine the weight-based amoxicillin dose by first dividing the client's documented weight of 75 kg by 2.2.
  6. Collaborate with the registered nurse to administer the intravenous bumetanide and subsequently monitor the client's fluid output.Answer

Answer

The correct actions are to review the client's serum potassium level prior to administering the digoxin, and to collaborate with the registered nurse to administer the intravenous bumetanide while monitoring the client's fluid output.
The practical nurse demonstrates safe pharmacological practice by recognizing that loop diuretics like bumetanide deplete potassium, which requires checking serum potassium levels before giving digoxin to prevent toxicity. Furthermore, the nurse correctly identifies that intravenous push medications are outside the LPN/LVN scope of practice and collaborates with the RN for administration while monitoring therapeutic outcomes.

Step-by-Step Solution

1
Analyze the client's clinical presentation and prescribed medications.
The client has a high fever (102.4°F), requires an IV push loop diuretic (bumetanide), an oral cardiac glycoside (digoxin), a weight-based antibiotic, and an immunization.
Identifying the clinical context is essential for prioritizing care and recognizing safety contraindications.
2
Evaluate the scope of practice regarding intravenous medications.
The PN determines that administering IV push bumetanide is out of scope and must be delegated to or performed by the RN.
LPN/LVNs are generally prohibited from administering IV push medications due to the rapid systemic onset and required advanced assessment capabilities.
3
Assess pharmacological interactions between the prescribed medications.
Bumetanide is a loop diuretic that depletes potassium, which subsequently increases the risk of digoxin toxicity.
The PN must ensure the serum potassium is normal before giving digoxin to prevent fatal cardiac dysrhythmias.
4
Determine the appropriateness of the influenza immunization.
The PN recognizes that a severe acute febrile illness is a contraindication and the vaccine must be withheld.
Administering vaccines during acute febrile illness can exacerbate symptoms or mask adverse vaccine reactions.
5
Apply the rights of medication administration and basic dosage calculation rules.
The PN identifies that two active identifiers are always required, and that a weight already in kilograms should not be divided by 2.2.
Bypassing safety checks or misapplying conversion factors leads to critical medication administration errors.

Key Concept

Safe Medication Administration, Contraindications, and PN Scope of Practice
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Topics

Pharmacological Therapies

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