In the ED management of a patient with chest pain, which action must be performed by the RN rather than a licensed practical/vocational nurse?

• A. Attaching cardiac monitor leads
• B. Obtaining a 12-lead ECG
• C. Administering aspirin 162 mg
• D. Giving heparin IV push

Answer: (D)

In this ED chest-pain scenario, the action that must be performed by the RN is administering IV heparin. Heparin is a high-risk anticoagulant used in acute coronary syndrome protocols, and its administration requires precise dosing, rapid IV delivery, and close, ongoing monitoring of the patient’s coagulation status and potential bleeding. The RN is responsible for evaluating contraindications, adjusting therapy based on lab results (like aPTT), and recognizing signs of complications such as active bleeding or heparin-induced thrombocytopenia, then acting quickly to modify or stop therapy if needed.

Other tasks described—like attaching cardiac monitor leads, obtaining a 12-lead ECG, or administering aspirin under standing orders—are typically within the scope of LPN/LVN practice under appropriate protocols. These involve data collection and routine initial management, whereas IV heparin administration requires the RN’s broader assessment, critical monitoring, and ability to respond to rapid changes in the patient’s condition.