A practical nurse is preparing 0900 medications for a client with stage 4 chronic kidney d… — NCLEX-PN

A practical nurse is preparing 0900 medications for a client with stage 4 chronic kidney disease. The electronic health record indicates the client is prescribed oral carvedilol, lisinopril, and calcium acetate. Morning laboratory results reveal a serum potassium level of $6.2\text{ mEq/L}$ and a serum calcium level of $8.1\text{ mg/dL}$ . The client's vital signs are blood pressure $142/88\text{ mm Hg}$ , heart rate $64\text{ bpm}$ , and respiratory rate $18/\text{min}$ . Which action is most appropriate for the practical nurse to take?

A
Administer all scheduled medications because the elevated blood pressure indicates the antihypertensives are clinically necessary.
B
Obtain a prescription to administer intravenous calcium gluconate to stabilize the client's myocardium.
Withhold the lisinopril and promptly notify the registered nurse of the laboratory findings.Cevap
D
Administer the lisinopril but withhold the calcium acetate because the client's serum calcium level is below the normal reference range.

Cevap

The practical nurse should withhold the lisinopril and immediately notify the registered nurse of the hyperkalemia.

The client has a critically elevated serum potassium level of

6.2\text{ mEq/L}

(normal is

3.5

5.0\text{ mEq/L}

). Lisinopril is an ACE inhibitor, a class of drugs known to cause potassium retention. Administering this medication would further dangerously elevate the client's potassium, increasing the risk of fatal cardiac dysrhythmias. The practical nurse's priority within their scope of practice is to withhold the medication and immediately report the critical finding to the registered nurse.

Adım Adım Çözüm

Analyze the morning laboratory results against normal reference ranges.

The potassium level is

6.2\text{ mEq/L}

(critically high) and the calcium level is

8.1\text{ mg/dL}

(mildly low).

Identifying abnormal laboratory values is a mandatory safety check before administering pharmacological therapies.

Evaluate the prescribed medications for contraindications based on the laboratory findings.

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor, which retains potassium and is highly contraindicated with a potassium level of

6.2\text{ mEq/L}

Administering a potassium-sparing medication to a hyperkalemic client can lead to lethal cardiac dysrhythmias.

Determine the most appropriate intervention within the practical nurse scope of practice.

The nurse must withhold the contraindicated medication (lisinopril) and immediately escalate the critical lab value to the supervising registered nurse.

The practical nurse cannot independently alter medical orders or administer intravenous push medications, but has a duty to withhold harmful medications and report critical findings.

Anahtar Kavram

Recognizing pharmacological contraindications (ACE inhibitors exacerbating hyperkalemia) and adhering to the practical nurse scope of practice when managing critical laboratory values.

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Cevap

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