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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is assigned to a team of clients on a step-down unit. Which medication administration action demonstrates appropriate clinical judgment and adherence to the PN scope of practice?

  1. A
    Delivering a prescribed dose of intravenous (IV) push hydromorphone to a client experiencing acute postoperative pain.
  2. B
    Preparing the live-attenuated varicella vaccine for a client actively undergoing high-dose systemic corticosteroid therapy.
  3. C
    Providing a scheduled dose of oral pantoprazole using only visual recognition for a client admitted three weeks prior.
  4. Withholding a prescribed dose of oral atenolol and alerting the registered nurse after auscultating an apical pulse of 52 beats per minute.Answer

Answer

The correct action is withholding the prescribed dose of oral atenolol and alerting the registered nurse after auscultating an apical pulse of 52 beats per minute.
Atenolol is a beta-adrenergic blocking agent that reduces myocardial workload and heart rate. Prior to administering any beta-blocker, the nurse must assess the client's apical pulse. If the heart rate is less than 60 beats per minute in an adult, the safe and appropriate action within the PN scope of practice is to withhold the medication and promptly notify the registered nurse or healthcare provider to prevent severe bradycardia and decreased cardiac output.

Step-by-Step Solution

1
Evaluate each action against the established practical nurse (PN) scope of practice.
IV push medications are identified as an RN responsibility, eliminating the hydromorphone option.
Maintaining practice boundaries ensures client safety during high-risk medication administration.
2
Analyze the remaining options for pharmacological contraindications.
Live vaccines are contraindicated in immunosuppressed clients, eliminating the varicella vaccine option.
Systemic corticosteroids suppress the immune system, making live vaccines dangerous.
3
Review the options for adherence to fundamental medication safety protocols.
Visual recognition is not an acceptable identifier, eliminating the pantoprazole option.
Two unique identifiers are universally required prior to any medication administration.
4
Assess the final option for correct pre-administration parameters.
Withholding a beta-blocker for a heart rate below 60 beats per minute and reporting it to the RN is the correct, safe action.
Beta-blockers lower heart rate; administering them to a bradycardic client can cause severe hemodynamic compromise.

Key Concept

The practical nurse must integrate pharmacology knowledge (drug effects and contraindications), safety protocols (medication rights), and scope of practice (withholding vs. administering IV push) to ensure safe client care.
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Topics

Pharmacological Therapies

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