While providing oral care for a client who is unconscious, the practical nurse (PN) positions the client laterally and uses a basin to collect secretions. Which intervention is best for the PN to implement?

A. Synergistic actions: Synergistic effects occur when two drugs enhance each other’s action, but they are not the primary concern after one week of stable medication use. While important to monitor, they are less critical than cumulative effects in older adults who have slower drug metabolism.
B. Cumulative effects: Cumulative effects are the most important to assess in an older adult because aging decreases liver and kidney function, slowing drug metabolism and excretion. This can lead to drug buildup in the body, increasing the risk of toxicity even when medications have been taken as prescribed.
C. Idiosyncratic responses: Idiosyncratic reactions are unpredictable and not dose-dependent. They are important but tend to occur early in therapy rather than after a week of consistent medication use, making them less of a focus at this stage.
D. Antagonistic reactions: Antagonistic reactions, where drugs block each other's effects, are possible but would generally present early during therapy. After a week of stable use without new drugs added, cumulative buildup remains the greater priority for safe ongoing care.

A. Standards of practice for practical nursing: While important for general nursing care, national or professional standards do not replace the specific legal requirements outlined by the state’s licensing authority, which directly govern what a PN can and cannot do.
B. The licensing state's PN scope of practice: Each state defines the legal scope of practice for practical nurses, including what tasks they are authorized to perform. Reviewing the specific state's scope of practice ensures the PN practices legally and professionally in the new employment setting.
C. Geriatric standards of care guidelines: Geriatric care guidelines help provide quality care for older adults but are not the first priority when ensuring lawful nursing practice across state lines. Legal requirements must be understood first.
D. The employing agency's procedure manuals: While agency policies are important for specific job performance, they must be aligned with the state's legal scope of practice. Knowing the legal boundaries first is crucial before following any workplace procedures.