A client with a prescription for morphine sulfate 0.2 mg intravenously every 4 hours as needed for pain reports that pain is a 10 out of 10 on the numeric pain scale one hour after receiving the last administration. Which intervention should the nurse implement?
Contact the healthcare provider about the frequency of pain medication.
Encourage the client to allow more time for the medication to work.
Review the medical record for additional pain medication prescriptions.
Administer an additional dose of morphine sulfate 0.2 mg intravenously.
The Correct Answer is C
Choice A Reason: This is incorrect because contacting the healthcare provider about the frequency of pain medication is a dependent intervention that requires an order from the provider. The nurse should first use independent interventions such as reviewing available prescriptions or providing non-pharmacological measures.
Choice B Reason: This is incorrect because encouraging the client to allow more time for the medication to work can imply that the nurse does not believe or validate the client's report of pain. It also can delay effective pain relief and increase suffering.
Choice C Reason: This is correct because reviewing the medical record for additional pain medication prescriptions can help identify alternative or adjunctive options for pain management, such as breakthrough doses, rescue doses, or non-opioid analgesics.
Choice D Reason: This is incorrect because administering an additional dose of morphine sulfate 0.2 mg intravenously can cause overdose, respiratory depression, or addiction. The nurse should follow the prescribed dosage, route, and interval of administration and monitor for adverse effects.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason: This is incorrect because regular exercise is a beneficial lifestyle modification for preventing and managing cardiac disease, but it is not the most important one. Smoking cessation has a greater impact on reducing the risk of cardiovascular events and mortality.
Choice B Reason: This is incorrect because stress reduction is a helpful lifestyle modification for preventing and managing cardiac disease, but it is not the most important one. Smoking cessation has a more direct effect on improving the function and structure of the blood vessels and heart.
Choice C Reason: This is correct because smoking cessation is the most important lifestyle modification for preventing and managing cardiac disease, as smoking is a major modifiable risk factor that can cause atherosclerosis, hypertension, arrhythmias, thrombosis, and myocardial infarction.
Choice D Reason: This is incorrect because a low-fat diet is a useful lifestyle modification for preventing and managing cardiac disease, but it is not the most important one. Smoking cessation has a stronger influence on lowering the levels of cholesterol and inflammation in the blood.
Correct Answer is C
Explanation
Choice A Reason: This is incorrect because waiting for notification that the system has been rebooted can delay the client's care and compromise safety. The nurse should report the problem as soon as possible and use alternative methods of documentation.
Choice B Reason: This is incorrect because identifying information as late entry in the record is a secondary action that should be done after the system is restored. The nurse should prioritize resolving the technical issue and ensuring continuity of care.
Choice C Reason: This is correct because notifying information services department of the situation is the first action that the nurse should take to alert the experts who can troubleshoot and fix the problem. The nurse should also follow the facility's policy and procedure for documenting in a downtime situation.
Choice D Reason: This is incorrect because printing electronic medical record (EMR) from backup server may not be feasible or accessible depending on the extent of the system failure. The nurse should use paper forms or charts as a temporary measure until the system is back online.
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