# The nurse reviews newly entered prescriptions for assigned clients. Which prescriptions require follow-up before implementation? Highlight the findings that present an immediate safety concern.

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> subject: Assignment/Delegation/Supervision  
> category: MOC

## Question

The nurse reviews newly entered prescriptions for assigned clients. Which prescriptions require follow-up before implementation? Highlight the findings that present an immediate safety concern.

| Client data | New prescription |
| --- | --- |
| Atrial fibrillation; apical pulse 78/min | Give metoprolol 25 mg orally; hold if pulse is below 60/min. |
| Postoperative; respirations 8/min and difficult to arouse | Give morphine 4 mg intravenously now for severe postoperative pain. |
| Heart failure; potassium 3.2 mEq/L and urine output adequate | Give potassium chloride 20 mEq diluted in prescribed intravenous fluid. |
| Pneumonia; cultures collected and no listed allergy | Begin the prescribed intravenous antibiotic after pharmacy verification. |
| New deep-vein thrombosis; platelet count 38,000/mm³ | Give enoxaparin 1 mg/kg subcutaneously every 12 hours. |
| Pulmonary edema; blood pressure 168/92 mm Hg | Give prescribed intravenous furosemide and monitor urine output. |
| Diabetes; glucose 68 mg/dL and meal tray delayed | Give 12 units of rapid-acting insulin before the meal arrives. |
| Chest pain; blood pressure 146/84 mm Hg | Give prescribed sublingual nitroglycerin and reassess blood pressure. |
| Potassium 2.8 mEq/L; peripheral intravenous access | Give potassium chloride concentrate 20 mEq by direct IV push now. |

## Explanation

Clarify prescriptions that conflict with current respiratory, bleeding, glucose, or infusion-safety data. A nurse should pause an unsafe order and use the chain of communication before implementation.

## In-depth explanation

Quick answer
Clarify the morphine order for a respiratory rate of 8/min, enoxaparin with platelets of 38,000/mm³, rapid-acting insulin when glucose is 68 mg/dL and food is unavailable, and concentrated potassium chloride ordered by IV push.

Why this is correct
Each selected prescription bypasses a current safety barrier. Opioids can worsen respiratory depression, anticoagulation can compound severe thrombocytopenia, rapid-acting insulin can deepen hypoglycemia without carbohydrate, and concentrated potassium chloride must be diluted and infused rather than injected directly.[2]

Easy analogy or mental picture
Think of the nurse as the final gate before a medication reaches the client. A red warning light means close the gate, verify the data, and call through the approved chain; it does not mean silently cancel treatment or invent a replacement order.

Memory hook
Breathing, bleeding, glucose, and IV concentration: stop at the red signal.

NCLEX decision rule
When an order conflicts with the client's current assessment or a nonnegotiable administration rule, hold implementation and clarify. Do not carry out a dangerous order merely because it appears in the electronic record.

Why the other choices are wrong
The remaining prescriptions include the necessary indication, monitoring, route, or hold parameter and fit the displayed client data. They still require routine medication checks, but the record does not show the same immediate contradiction.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]FDA: Potassium Chloride for Injection ConcentrateU.S. Food and Drug Administration

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