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Zorluk: OrtaPharmacological Therapies

A practical nurse (PN) is reviewing the medication administration record for an adult client with a history of heart failure. The client is scheduled to receive oral digoxin and oral furosemide. Additionally, a new prescription for intravenous (IV) push furosemide was just added to the chart. The client's morning vital signs include a heart rate of 56 beats/min56\text{ beats/min} and a blood pressure of 118/74 mm Hg118/74\text{ mm Hg}. The morning serum potassium level is 3.1 mEq/L3.1\text{ mEq/L}. Which of the following actions should the PN take? Select all that apply.

  1. Withhold the scheduled dose of oral digoxin.Cevap
  2. Notify the registered nurse (RN) regarding the client's vital signs and laboratory results.Cevap
  3. Document the withheld medications and the clinical reasons for withholding them in the electronic health record.Cevap
  4. D
    Administer the intravenous (IV) push furosemide slowly over 2 minutes.
  5. E
    Administer the oral furosemide as scheduled to manage the client's heart failure symptoms.
  6. F
    Bypass the barcode scanner and manually verify the oral medications if the scanning device is temporarily unavailable.

Cevap

The correct actions are to withhold the scheduled dose of oral digoxin, notify the registered nurse (RN) regarding the vital signs and laboratory results, and document the withheld medications and the reasons for withholding them in the electronic health record.
The practical nurse must apply clinical knowledge and strictly adhere to their scope of practice. Oral digoxin should be withheld because the client's heart rate is below 60 beats/min, and the presence of hypokalemia (potassium 3.1 mEq/L) dangerously increases the risk of digoxin toxicity. Oral furosemide must also be withheld because it is a potassium-wasting diuretic that would exacerbate the low potassium level. The RN must be immediately notified of these critical findings so the provider can adjust the treatment plan. Finally, standard nursing practice requires thorough documentation whenever a scheduled medication is withheld, including the rationale.

Adım Adım Çözüm

1
Evaluate the client's vital signs against medication parameters.
The heart rate is 56 beats/min. Digoxin must be held for a heart rate less than 60 beats/min in an adult.
Digoxin has a negative chronotropic effect (slows heart rate) and could cause symptomatic bradycardia.
2
Evaluate the client's laboratory results against the scheduled medications.
The serum potassium is 3.1 mEq/L (normal: 3.5-5.0 mEq/L). Furosemide wastes potassium and must be held. Hypokalemia also increases the risk of digoxin toxicity.
Administering furosemide will exacerbate the hypokalemia, and the low potassium makes the heart muscle more sensitive to digoxin, increasing toxicity risk.
3
Determine the practical nurse's scope of practice for the new IV push prescription.
IV push furosemide cannot be administered by the PN.
The administration of IV push medications requires advanced assessment and clinical judgment reserved for the RN scope of practice.
4
Formulate a safe clinical response.
Hold the oral digoxin and furosemide, decline the IV push medication, notify the RN, and accurately document the withheld medications.
This comprehensively ensures client safety, maintains adherence to the scope of practice, and fulfills legal documentation standards.

Anahtar Kavram

Medication administration safety, LPN/VN scope of practice, and critical lab value interpretation
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Pharmacological Therapies

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