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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is reviewing the electronic health record (EHR) of a 7272-year-old client prior to morning medication administration.

Client Profile & VitalsCurrent PrescriptionsAvailable Supply
Age: 7272 yearsCefuroxime 500 mg500 \text{ mg} PO BIDCefuroxime 500 mg500 \text{ mg} tablets
Allergy: Penicillin (Anaphylaxis)Furosemide 40 mg40 \text{ mg} IV push dailyFurosemide 10 mg/mL10 \text{ mg/mL} vial
HR: 88 beats/min88 \text{ beats/min}Guaifenesin 400 mg400 \text{ mg} PO every 6 hoursGuaifenesin liquid 200 mg/10 mL200 \text{ mg}/10 \text{ mL}
BP: 138/82 mm Hg138/82 \text{ mm Hg}Live attenuated influenza vaccine (LAIV) intranasal statLAIV single-dose nasal sprayer
RR: 18 breaths/min18 \text{ breaths/min}

Based on the provided data, which of the following actions reflect safe pharmacological practice by the PN? Select all that apply.

  1. Withhold the prescribed cefuroxime and notify the registered nurse (RN) or healthcare provider due to the client's allergy history.Answer
  2. B
    Administer the live attenuated influenza vaccine (LAIV) intranasally as prescribed to provide immediate protection.
  3. C
    Draw up 4 mL4 \text{ mL} of furosemide and administer it via slow intravenous (IV) push over 2 minutes.
  4. Inform the RN that the intravenous (IV) furosemide prescription requires administration by a registered nurse.Answer
  5. E
    Pour 40 mL40 \text{ mL} of the guaifenesin liquid into a medication cup to achieve the prescribed dose.
  6. F
    Verify the client's identity prior to administration by confirming the room number and the bed assignment.

Answer

The correct actions indicate withholding the cefuroxime due to the severe penicillin allergy and notifying the RN that the IV push furosemide is outside the PN scope of practice.
Safe pharmacological practice requires synthesizing multiple data points before administration. The practical nurse must recognize that an anaphylactic allergy to penicillin strictly contraindicates the use of cephalosporins (like cefuroxime) due to cross-sensitivity. Furthermore, the PN must practice within legal boundaries; because IV push administration is an RN-level skill in most jurisdictions, the PN correctly communicates this limitation to the RN to ensure the client receives the furosemide safely.

Step-by-Step Solution

1
Analyze the cefuroxime prescription against the client's allergy profile.
Cefuroxime is a cephalosporin. The client has an anaphylactic allergy to penicillin, posing a high risk for cross-sensitivity.
Administering a cephalosporin to a client with a severe penicillin allergy is a critical safety risk requiring the medication to be withheld.
2
Evaluate the furosemide prescription against the PN scope of practice.
The medication is ordered as an IV push.
Administration of IV push medications requires advanced assessment and clinical judgment, which falls under the RN scope of practice, not the PN.
3
Calculate the correct dosage for the guaifenesin liquid.
Dose ordered is 400 mg400 \text{ mg}; concentration is 200 mg/10 mL200 \text{ mg}/10 \text{ mL}. Calculation: (400/200)×10=2×10=20 mL(400 / 200) \times 10 = 2 \times 10 = 20 \text{ mL}.
Ensures mathematical accuracy to prevent overmedication or undermedication.
4
Assess the appropriateness of the LAIV prescription based on client demographics.
The client is 7272 years old.
The live attenuated influenza vaccine (LAIV) is contraindicated for adults 50 years of age and older; they should receive the inactivated vaccine instead.

Key Concept

Medication Safety, Contraindications, and Scope of Practice
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Topics

Pharmacological Therapies

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