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Zorluk: ZorPharmacological Therapies

A practical nurse (PN) is reviewing the medication administration record and morning laboratory results for a client with end-stage renal disease. The client is scheduled to receive oral sevelamer, subcutaneous epoetin alfa, and oral lisinopril. The laboratory results indicate a serum potassium of 5.8 mEq/L, hemoglobin of 11.5 g/dL, and serum phosphorus of 6.5 mg/dL. The client's blood pressure is 148/88 mm Hg. Which of the following actions should the PN take? Select all that apply.

  1. Withhold the scheduled dose of oral lisinopril.Cevap
  2. Notify the registered nurse (RN) regarding the client's laboratory results.Cevap
  3. Administer the oral sevelamer while the client is eating their morning meal.Cevap
  4. D
    Administer the scheduled subcutaneous epoetin alfa to treat the client's anemia.
  5. E
    Verify the client's identity using their bed and room number prior to administration.
  6. F
    Independently enter a prescription for a stat electrocardiogram (ECG) to monitor for arrhythmias.

Cevap

The correct actions are to withhold the oral lisinopril, notify the registered nurse (RN) of the laboratory results, and administer the oral sevelamer with the client's meal.
In a client with end-stage renal disease, managing medications around critical laboratory values is essential. Lisinopril (an ACE inhibitor) must be withheld because it can exacerbate the client's hyperkalemia (potassium 5.8 mEq/L). The phosphate binder sevelamer must be administered directly with meals to effectively bind to dietary phosphorus and lower the elevated serum phosphorus (6.5 mg/dL). Finally, the PN must strictly operate within their scope of practice by notifying the RN of these critical laboratory values and the withheld medications to ensure collaborative management.

Adım Adım Çözüm

1
Analyze the client's morning laboratory results against normal reference ranges.
The potassium (5.8 mEq/L) is high, hemoglobin (11.5 g/dL) is above the target range for epoetin therapy, and phosphorus (6.5 mg/dL) is high.
Recognizing critical laboratory values is the first step in ensuring safe medication administration.
2
Evaluate the scheduled medications in relation to the abnormal laboratory findings.
Lisinopril worsens hyperkalemia, epoetin alfa is contraindicated with hemoglobin > 11.0 g/dL, and sevelamer treats hyperphosphatemia when given with food.
Medications must be correlated with current data to determine if they should be administered or withheld.
3
Determine the appropriate interventions within the practical nurse scope of practice.
The PN must withhold the unsafe medications (lisinopril, epoetin alfa), administer the safe medication correctly (sevelamer with meals), and escalate the findings to the RN.
The PN is responsible for safe medication administration and timely reporting of significant changes.

Anahtar Kavram

Pre-administration Assessment of Laboratory Values and PN Scope of Practice
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Konular

Pharmacological Therapies

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