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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is planning care and medication administration for a group of assigned clients. Which of the following actions by the PN demonstrate safe pharmacological practice within the practical nursing scope of practice? Select all that apply.

  1. Identifying a client by asking them to state their name and date of birth while verifying it against the medication administration record.Answer
  2. B
    Administering an intravenous (IV) push dose of a narcotic analgesic for a client experiencing acute severe pain.
  3. Withholding a scheduled dose of oral digoxin for an adult client with an apical pulse of 54 beats/minute and notifying the supervising registered nurse.Answer
  4. D
    Administering a live attenuated viral vaccine to a client who is currently undergoing immunosuppressive chemotherapy.
  5. Reinforcing the registered nurse's teaching about the importance of reporting dark, tarry stools to a client prescribed warfarin.Answer
  6. F
    Estimating a pediatric liquid medication volume based on the child's age rather than calculating the exact weight-based dosage.

Answer

The correct actions are identifying the client using two identifiers, withholding digoxin for bradycardia and notifying the registered nurse, and reinforcing teaching about bleeding precautions for a client on warfarin.
The practical nurse demonstrates safe practice by always using two client identifiers before medication administration, which is a fundamental safety right. Withholding digoxin for an adult with an apical pulse below 60 beats/minute and notifying the registered nurse is the correct clinical protocol to prevent cardiac toxicity. Additionally, reinforcing previous teaching provided by the registered nurse regarding medication side effects, such as signs of internal bleeding with warfarin, is directly within the practical nursing scope of practice.

Step-by-Step Solution

1
Analyze each action to determine if it falls within the practical nurse (PN) scope of practice.
The PN scope of practice includes administering oral medications, reinforcing teaching, and reporting abnormal findings, but generally excludes administering high-risk IV push medications.
Ensuring actions are within scope prevents legal violations and protects client safety.
2
Evaluate the medication safety principles and clinical judgment for each scenario.
Identifying clients with two identifiers, checking an apical pulse before digoxin, and recognizing bleeding risks with warfarin are standard safe practices.
These actions adhere to the rights of medication administration and prevent severe adverse outcomes.
3
Identify contraindicated or unsafe pharmacological actions.
Giving live vaccines to immunosuppressed clients and estimating pediatric weight-based doses are highly unsafe practices.
These actions ignore critical contraindications and mathematical safety standards, potentially causing fatal harm.

Key Concept

Safe Medication Administration and Practical Nurse Scope of Practice
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Topics

Pharmacological Therapies

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