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Difficulty: Very hardPharmacological Therapies

A practical nurse is caring for a client who is 4 hours postoperative following an open cholecystectomy. The registered nurse (RN) is managing the client's continuous intravenous (IV) fluids and delegates the administration of scheduled oral metoprolol, oral oxycodone, and a PRN dose of IV push ondansetron to the practical nurse. The client's current vital signs are blood pressure 86/52 mmHg, heart rate 118 bpm, and respiratory rate 16 breaths/min. The client reports a pain level of 7 on a 0 to 10 scale. Which action should the practical nurse take first?

  1. Refuse the delegated intravenous push medication, withhold the oral medications, and immediately report the vital signs to the registered nurse.Answer
  2. B
    Accept the delegation to administer both the oral and intravenous medications to ensure timely pain and nausea relief for the postoperative client.
  3. C
    Inform the registered nurse that intravenous push medications are out of scope, but proceed with administering the scheduled oral metoprolol.
  4. D
    Prioritize pain management by administering the oral oxycodone immediately, then request the registered nurse to administer the antiemetic.

Answer

The practical nurse must refuse the out-of-scope intravenous push medication, withhold the oral antihypertensive and opioid medications due to the client's hemodynamic instability, and immediately report the findings to the supervising registered nurse.
The client's vital signs (blood pressure 86/52 mmHg, heart rate 118 bpm) indicate potential hypovolemic shock or hemorrhage, which is a circulation (ABC) priority. Metoprolol (a beta-blocker) and oxycodone (an opioid) both lower blood pressure and must be withheld to prevent cardiovascular collapse. Additionally, administering IV push medications like ondansetron is outside the practical nurse's scope of practice. The nurse must refuse the unsafe delegation and escalate the critical clinical findings to the registered nurse immediately.

Step-by-Step Solution

1
Analyze the delegated tasks against the practical nurse scope of practice.
Administration of intravenous push medications (ondansetron) is identified as out of scope and must be refused.
Nursing practice acts generally prohibit practical nurses from administering medications via the intravenous push route.
2
Evaluate the client's current vital signs in the context of their postoperative status.
Blood pressure of 86/52 mmHg and a heart rate of 118 bpm are identified as critical abnormalities.
These vital signs in a 4-hour postoperative client strongly suggest early hypovolemic or hemorrhagic shock, requiring immediate attention.
3
Analyze the pharmacological effects of the scheduled oral medications on the client's current physiological state.
Both metoprolol (a beta-blocker) and oxycodone (an opioid) are identified as contraindicated.
Metoprolol lowers blood pressure and heart rate, while oxycodone causes vasodilation and lowers blood pressure; both would exacerbate the client's cardiovascular compromise.
4
Determine the priority nursing action based on scope and safety.
Withhold the oral medications, refuse the IV push task, and escalate immediately to the registered nurse.
Immediate RN assessment and intervention (such as IV fluid boluses) are required to manage the hemodynamic instability.

Key Concept

The practical nurse must strictly adhere to their scope of practice by refusing IV push delegations, while concurrently utilizing clinical judgment to withhold medications (like beta-blockers and opioids) that would exacerbate early signs of shock.
Estimated Time:1m 30s
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Pharmacological Therapies

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