Two weeks after cast application, a client with a fractured right arm returns to the clinic for evaluation. The client seems upset and tells the practical nurse (PN) that the healthcare provider said a callus has formed on the bone. Which action should the PN take?

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.

Ataxia: Phenytoin can cause problems with coordination and balance, leading to ataxia. The PN should monitor the client for unsteady gait or difficulty with movements.

Drowsiness: Phenytoin can cause drowsiness or sedation. The PN should observe the client for excessive sleepiness or difficulty staying awake.

Altered blood coagulation: Phenytoin can affect blood clotting factors, potentially leading to altered blood coagulation. The PN should assess the client for any signs of bleeding or bruising.

Vertigo: Phenytoin can cause dizziness or vertigo, which is a spinning sensation. The PN should be alert for complaints of dizziness or any difficulty with balance.

Visual disturbances: Phenytoin can cause visual disturbances, such as blurred vision or double vision. The PN should monitor the client's vision and report any changes.

The following options are incorrect regarding the toxic effects of phenytoin:

• Anxiety: Anxiety is not a recognized toxic effect of phenytoin. However, it is important to assess the client for any signs of anxiety or emotional changes.
• Aphasia: Aphasia refers to a language impairment and is not typically associated with the toxic effects of phenytoin.
• Vomiting: While phenytoin can cause gastrointestinal side effects, such as nausea and vomiting, it is not directly related to its toxic effects. However, the PN should still monitor the client for any signs of nausea or vomiting.