A nurse is caring for a client who is receiving furosemide IV every 6 hr. Which of the following new prescriptions should the nurse recognize as a potential interaction?

Otic medication administration involves the instillation of sterile or non-sterile solutions into the external auditory canal. Proper positioning of the auricleis essential to straighten the ear canal and ensure the medication reaches the tympanic membrane.

Rationale:

A.Pulling the pinna up and back is the correct technique for an adult client to straighten the external auditory canal. This maneuver allows the drops to flow freely toward the eardrum rather than becoming trapped in the curves of the canal. For children under the age of 3, the nurse should teach the caregiver to pull the pinna down and back instead to achieve the same result.

B.Lying flat in bed is not the ideal position for receiving otic drops, as the medication may not flow deep enough into the canal. The client should be in a side-lying position with the affected ear facing upward to facilitate the gravitational flow of the solution. This position should be maintained for several minutes after instillation to ensure maximum absorption and prevent the medication from leaking out.

C.Cooling otic drops before administration is incorrect because cold solutions can cause extreme discomfort and trigger a vestibular response known as the caloric reflex. This reflex can result in severe vertigo, nausea, and nystagmus. Caregivers should be instructed to warm the medication container by rolling it between their hands to reach body temperature, ensuring a more comfortable and safe administration.

D.Tilting the head back is a technique used for ophthalmic or nasal instillations rather than otic medications. For the ear, the head must be tilted toward the opposite shoulder so the affected ear is horizontal and pointing toward the ceiling. Tilting the head backward would cause the drops to run down the side of the face rather than entering the ear canal effectively.

Morphine is an opioid agonistthat binds to mu-opioid receptors in the central nervous system to provide potent analgesia. Beyond pain relief, it exerts a depressant effecton the respiratory center and the autonomic nervous system, necessitating continuous monitoring of the patient's level of consciousness and hemodynamic stability.

Rationale:

A.Tachycardia is not a typical adverse effect of morphine; in fact, opioids tend to cause a decrease in heart rate or have no significant effect on it. Morphine reduces sympathetic outflow, which is more likely to result in bradycardia or a stable heart rate. The presence of tachycardia in a patient on a PCA pump might actually indicate inadequately controlled pain or a different underlying complication.

B.Sedation is a common and significant adverse effect of morphine that often precedes respiratory depression in patients using a PCA pump. The nurse must use a standardized scale to assess the client's arousal level, as excessive sleepiness indicates the drug is accumulating to potentially toxic levels. Monitoring for sedation allows the nurse to intervene early by adjusting the dose before life-threatening complications occur.

C.Hypotension occurs with morphine administration due to peripheral vasodilation and the release of histamine, which lowers systemic vascular resistance. This is particularly common when the drug is administered intravenously or in large doses via a PCA pump. The nurse must monitor blood pressure regularly and instruct the client to change positions slowly to prevent orthostatic hypotension and potential falls during therapy.

D.Hyperthermia is not an adverse effect associated with opioid analgesics like morphine. Morphine does not interfere with the thermoregulatory center in the hypothalamus in a way that would cause an elevated body temperature. If a patient receiving morphine develops a fever, the nurse should investigate other causes, such as an underlying infection or an inflammatory process, rather than attributing it to the medication.

E.Bradypnea, or an abnormally slow respiratory rate, is one of the most dangerous adverse effects of morphine because it directly depresses the brainstem respiratory centers. The nurse must count the client's respirations frequently and be prepared to administer naloxone if the rate falls below 8 to 10 breaths per minute. Bradypnea can lead to hypercapnia and respiratory arrest, making it a critical focus of PCA monitoring.