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Difficulty: MediumPharmacological Therapies

During a morning assessment, a client receiving continuous total parenteral nutrition (TPN) appears diaphoretic and exhibits sudden confusion. The client's capillary blood glucose level is 4242 mg/dL. The client's medication administration record includes a PRN prescription for 5050 mL of 50%50\% dextrose in water (D50W) intravenous (IV) push for severe hypoglycemia. Based on the practical nurse scope of practice, which action is most appropriate?

  1. Promptly notify the registered nurse to administer the prescribed intravenous push medicationAnswer
  2. B
    Administer the 50%50\% dextrose intravenous push slowly through the central venous catheter
  3. C
    Assist the client to an upright position and provide four ounces of apple juice to drink
  4. D
    Document the critical blood glucose value and reassess the client's neurological status in 1515 minutes

Answer

The practical nurse should promptly notify the registered nurse to administer the prescribed intravenous push medication.
The client is experiencing a hypoglycemic emergency requiring immediate pharmacological intervention. Because the client has an altered mental status, oral intake is unsafe due to aspiration risks. The prescribed medication is an intravenous push, which is outside the scope of practice for a practical nurse. Therefore, the correct and safest action is to immediately notify the registered nurse, who can legally administer the IV push medication.

Step-by-Step Solution

1
Analyze the client's clinical presentation and blood glucose results.
The client has symptomatic hypoglycemia, indicated by diaphoresis and confusion, with a critical blood glucose of 4242 mg/dL.
Identifying the clinical emergency is the first step in prioritizing care.
2
Evaluate the safety of oral versus parenteral interventions.
Oral carbohydrates are contraindicated because the client's sudden confusion creates a high risk for aspiration.
Airway protection must be prioritized in clients with altered mental status.
3
Determine the appropriate administration of the prescribed pharmacological therapy within the practical nurse scope of practice.
The prescribed treatment is IV push D50W, which requires a registered nurse's scope of practice to administer safely.
Practical nurses must not accept tasks or administer medications that exceed their legal scope of practice, such as IV push medications.
4
Select the action that ensures safe, immediate client care.
Escalating the situation to the registered nurse immediately ensures the client receives the necessary emergency medication.
Immediate collaboration with the registered nurse is required for critical interventions that fall outside the practical nurse's scope.

Key Concept

Practical Nurse Scope of Practice in Emergency Pharmacological Interventions
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Topics

Pharmacological Therapies

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