,Chapter 01 — Pharmacology and the
Nursing Process in LPN Practice
Section: The LPN/VN’s Role and the Nursing Process
Subsection: Using the Clinical Judgment Model
Stem: A 72-year-old patient is prescribed warfarin. The LPN
notices the patient's INR from yesterday was 3.5 and that a new
antibiotic (trimethoprim–sulfamethoxazole) was added last
night. Using the Clinical Judgment Model, what is the nurse’s
best first action?
A. Administer the next scheduled warfarin dose as ordered.
B. Hold the warfarin dose and notify the RN/physician of the
interaction and elevated INR.
C. Encourage the patient to eat vitamin K–rich foods to lower
INR.
D. Document the INR value and proceed with routine care.
Correct Answer: B
Rationales:
• Correct: Holding warfarin and notifying the RN/physician is
prudent because trimethoprim–sulfamethoxazole
potentiates warfarin, and INR 3.5 increases bleeding risk;
this applies clinical judgment to prioritize patient safety.
• A: Administering warfarin without reporting ignores the
elevated INR and drug interaction, risking bleeding.
, • C: Recommending diet changes is not an immediate
corrective action for a potentially hazardous INR and drug
interaction.
• D: Documentation without reporting delays necessary
intervention and is unsafe.
Teaching Point: Always assess interactions and escalate when
INR is supratherapeutic with interacting drugs.
2.
Chapter 1 — Pharmacology and the Nursing Process in LPN
Practice
Section: The LPN/VN’s Role and the Nursing Process
Subsection: Using the Clinical Judgment Model
Stem: While preparing to give digoxin, the LPN notes the
patient’s apical pulse is 48 beats/min. Which clinical judgment-
based action should the LPN take?
A. Administer digoxin and recheck the pulse in one hour.
B. Withhold digoxin and notify the RN/physician before
administration.
C. Give half the dose to avoid toxicity.
D. Ask the patient to ambulate and then recheck the apical
pulse.
Correct Answer: B
Rationales:
, • Correct: Withholding digoxin and notifying the
RN/physician is appropriate—bradycardia (<60 bpm) is a
contraindication to digoxin and requires provider input.
• A: Administering would risk severe bradycardia and
possible toxicity.
• C: Splitting doses is not an evidence-based or safe strategy
without provider order.
• D: Ambulation may be unsafe and is not a reliable method
to resolve bradycardia before a cardiotropic medication.
Teaching Point: Hold digoxin for heart rate <60 bpm and report
immediately.
3.
Chapter 1 — Pharmacology and the Nursing Process in LPN
Practice
Section: The LPN/VN’s Role and the Nursing Process
Subsection: Using the Clinical Judgment Model
Stem: A patient refuses an opioid analgesic because of fear of
addiction. Which response by the LPN best demonstrates
application of the nursing process and clinical judgment?
A. Tell the patient “You need this medicine” and document
refusal only if persistent.
B. Explore the patient's concerns, provide education about
short-term use and safety, and notify the RN.
Nursing Process in LPN Practice
Section: The LPN/VN’s Role and the Nursing Process
Subsection: Using the Clinical Judgment Model
Stem: A 72-year-old patient is prescribed warfarin. The LPN
notices the patient's INR from yesterday was 3.5 and that a new
antibiotic (trimethoprim–sulfamethoxazole) was added last
night. Using the Clinical Judgment Model, what is the nurse’s
best first action?
A. Administer the next scheduled warfarin dose as ordered.
B. Hold the warfarin dose and notify the RN/physician of the
interaction and elevated INR.
C. Encourage the patient to eat vitamin K–rich foods to lower
INR.
D. Document the INR value and proceed with routine care.
Correct Answer: B
Rationales:
• Correct: Holding warfarin and notifying the RN/physician is
prudent because trimethoprim–sulfamethoxazole
potentiates warfarin, and INR 3.5 increases bleeding risk;
this applies clinical judgment to prioritize patient safety.
• A: Administering warfarin without reporting ignores the
elevated INR and drug interaction, risking bleeding.
, • C: Recommending diet changes is not an immediate
corrective action for a potentially hazardous INR and drug
interaction.
• D: Documentation without reporting delays necessary
intervention and is unsafe.
Teaching Point: Always assess interactions and escalate when
INR is supratherapeutic with interacting drugs.
2.
Chapter 1 — Pharmacology and the Nursing Process in LPN
Practice
Section: The LPN/VN’s Role and the Nursing Process
Subsection: Using the Clinical Judgment Model
Stem: While preparing to give digoxin, the LPN notes the
patient’s apical pulse is 48 beats/min. Which clinical judgment-
based action should the LPN take?
A. Administer digoxin and recheck the pulse in one hour.
B. Withhold digoxin and notify the RN/physician before
administration.
C. Give half the dose to avoid toxicity.
D. Ask the patient to ambulate and then recheck the apical
pulse.
Correct Answer: B
Rationales:
, • Correct: Withholding digoxin and notifying the
RN/physician is appropriate—bradycardia (<60 bpm) is a
contraindication to digoxin and requires provider input.
• A: Administering would risk severe bradycardia and
possible toxicity.
• C: Splitting doses is not an evidence-based or safe strategy
without provider order.
• D: Ambulation may be unsafe and is not a reliable method
to resolve bradycardia before a cardiotropic medication.
Teaching Point: Hold digoxin for heart rate <60 bpm and report
immediately.
3.
Chapter 1 — Pharmacology and the Nursing Process in LPN
Practice
Section: The LPN/VN’s Role and the Nursing Process
Subsection: Using the Clinical Judgment Model
Stem: A patient refuses an opioid analgesic because of fear of
addiction. Which response by the LPN best demonstrates
application of the nursing process and clinical judgment?
A. Tell the patient “You need this medicine” and document
refusal only if persistent.
B. Explore the patient's concerns, provide education about
short-term use and safety, and notify the RN.
