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Clinical Nursing Skills

What Should the Nurse Do?

Clinical Nursing SkillsWhat Should the Nurse Do?

What Should the Nurse Do?

Mrs. Smith, a 93-year-old female, was admitted with a hip fracture. The patient’s medical history includes a recent fall, memory loss, and difficulty swallowing. The provider places the following medication orders:
  • Tylenol 325 g PO Q4 hours
  • Ibuprofen 800 mg PO Q6 hours PRN pain
  • Tylenol 500 mg PO Q6 hours PRN pain
  • Aspirin 81 mg PO
1 .
Are there any medication orders the nurse should question? If so, which ones?
2 .
What considerations should the nurse give when a medication is ordered on a scheduled and PRN basis?
3 .
Which medication should be administered if the patient complains of pain?
4 .
How might the patient’s medical history potentially impact the administration of medications?
A new medication order is placed by the provider. Upon verifying the order, the nurse realizes the patient is allergic to the drug. The nurse calls the provider to inform them of the patient’s allergy. The provider appears aggravated and tells the nurse to administer the medication anyway.
5 .
Which patient “right” is the nurse concerned about in this scenario?
6 .
How should the nurse respond to the provider?
7 .
What additional steps might the nurse take to ensure patient safety?
Order: Acyclovir (Zovirax) 1 g IV Q8 hours. Supplied: 500 mg/10 mL. Therapeutic range: 10–15 mg/kg IV Q8 hours. Patient weight: 187 lb.
8 .
How many kilograms does the patient weigh?
9 .
What is the Q8 hour therapeutic range (in milligrams) based on the patient’s weight?
10 .
What is the Q8 hour therapeutic range (in grams) based on the patient’s weight?
11 .
Is the prescribed dose within the therapeutic range?
12 .
How many milliliters should the patient receive per dose?
13 .
How many milliliters should the patient receive per day?
The nurse is caring for a patient who just had surgery. IV pain medication is administered in the morning prior to the patient working with a physical therapist. Somewhat later in the morning, the nurse administers the patient’s first dose of enoxaparin (Lovenox) to reduce the risk of postoperative blood clots. Later in the day, the patient receives their first dose of Rocephin to prevent postoperative infection. Shortly after administering the Rocephin, the patient develops a rash and complains of itching. The following medications need to be documented in the patient’s chart:
  • 0845 AM—hydromorphone (Dilaudid) 1 mg IV
  • 1003 AM—enoxaparin (Lovenox) 40 mg SQ left lower abdomen
  • 1355 PM—ceftriazone (Rocephin) 1 g IV
  • 1415 PM—diphenhydramine hydrochloride (Benadryl) 25 mg IV
14 .
What assessments are needed prior to administering these medications?
15 .
What evaluations are needed after administering these medications?
16 .
How long after administration should the nurse perform these evaluations?
17 .
How should the nurse document these evaluations?
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