A male client attends a community support program for mentally impaired and chemical-abusing clients. The client tells the practical nurse (PN) that his drugs of choice are cocaine and heroin. What is the greatest health risk for this client?

This question is related to the responsibilities and scope of practice of a practical nurse (PN) and a medication aide. A medication aide is a certified nursing assistant (CNA) who is responsible for administering daily medication to patients under the supervision of a licensed nurse, such as a PN or a registered nurse (RN). A PN is a licensed nurse who can provide routine care, observe patients’ health, assist doctors and RNs, and communicate instructions to patients regarding medication, home-based care, and preventative lifestyle changes.

Based on this information, the best action that the PN should take in this situation is c. Assign the remainder of medication administration to another PN who is performing treatments. This is because it would ensure that the medication administration is completed by another licensed nurse who has the knowledge, skills, and authority to do so. The PN who is performing treatments may have some spare time or be able to rearrange their schedule to accommodate the additional task. The PN should also communicate with the other PN and the medication aide about the situation and document the change of assignment in the patients’ records.

Option a is not a good choice, because it would be unfair and unethical to deny the medication aide’s request to leave if they are sick. The medication aide’s health and well-being are also important, and forcing them to stay and work could compromise their safety and the quality of care they provide to the patients.

Option b is not a good choice, because it would be outside the scope of practice of the UAPs to give medications to the patients. UAPs are not trained or certified to administer medications, and doing so could pose serious risks to the patients’ health and safety. The PN would also be liable for any errors or adverse outcomes that may result from the UAPs’ actions.

Option d is not a good choice, because it would not solve the problem of the medication administration being incomplete. Documenting why the medications were not given is important, but it is not enough to ensure that the patients receive their prescribed drugs and treatments. The PN still has the responsibility to find a way to complete the medication administration or delegate it to another qualified and available person.

- Child abuse is the intentional or neglectful physical, emotional, or sexual harm or injury of a child by a parent, caregiver, or other person who has a relationship of trust or responsibility with the child. Child abuse can have serious and long-lasting consequences for the child's health, development, and well-being.
- The practical nurse (PN) has a legal and ethical duty to identify, report, and prevent child abuse. The PN should be alert for any signs and symptoms of child abuse, such as unexplained or inconsistent injuries, bruises, burns, fractures, or scars; behavioral changes, such as fear, anxiety, aggression, withdrawal, or depression; poor hygiene, nutrition, or growth; lack of supervision, medical care, or education; or sexualized behaviors or knowledge .
- The PN should also conduct a thorough and sensitive assessment of the child and the family situation, using open-ended questions, active listening, and non-judgmental attitude. The PN should compare the history and physical findings of the child with the expected developmental milestones and normal variations for the child's age and stage. The PN should also document any relevant information in an objective and factual manner .
- When the mother of a school-aged boy tells the PN that he fell out of a tree and hurt his arm and shoulder, the PN should assess the child's injury and compare it with the mother's explanation. The most significant indicator of possible child abuse in this scenario is if the injury description by the mother varies from the child's version. This may suggest that the mother is lying or covering up the true cause of the injury, which may be intentional or accidental harm by herself or someone else. A discrepancy between the mother's and the child's stories may also indicate that the child is afraid or coerced to hide the truth about the abuse .

- Therefore, option D is the correct answer, while options A, B, and C are incorrect.