A nurse is caring for a client who is receiving morphine intravenously. Which of the following findings indicates the client is experiencing morphine toxicity?

Rationale:

A. "Your child can return to school once the fever has subsided.": The absence of fever does not indicate the child is no longer contagious. The child can still transmit the varicella-zoster virus until all lesions have crusted, even if fever has resolved.

B. "Your child can return to school after a negative titer result.": Titer testing is not used to determine contagiousness in active varicella infection. It is typically used to confirm immunity, especially after vaccination or past exposure.

C. "Your child can return to school once the lesions have crusted over.": Varicella is contagious until all lesions have crusted, which usually occurs about 5–7 days after the onset of rash. Crusting marks the end of the infectious period, making it safe for the child to return to school.

D. "Your child can return to school 24 hours after beginning antibiotics.": Varicella is a viral illness, not treated with antibiotics unless there is a secondary bacterial infection. Antibiotics do not impact the contagious period of the viral illness.

Rationale:

• Encourage the client to discuss their feelings: Encouraging emotional expression is a key therapeutic approach in managing bulimia nervosa. It allows the client to explore underlying psychological issues, such as anxiety and fear of weight gain, which often contribute to disordered eating behaviors.
• Provide a reduced sodium diet: Sodium restriction is not indicated in this client. In fact, the client has a slightly low sodium level (134 mEq/L), and further restriction could worsen electrolyte imbalances, which are already contributing to cardiac instability.
• Request a prescription for fluoxetine: Fluoxetine, an SSRI, is approved for the treatment of bulimia nervosa and can reduce the frequency of binge-purge episodes. It is also effective in treating coexisting anxiety or depressive symptoms, which are common in this population.
• Request a prescription for bupropion: Bupropion is contraindicated in clients with eating disorders due to its seizure risk. In clients with bulimia, frequent vomiting and low electrolytes increase this risk significantly, making bupropion an inappropriate choice.
• Monitor daily intake and output: Monitoring intake and output helps evaluate hydration status and kidney function, both of which may be compromised due to chronic purging. It also helps track nutritional rehabilitation and prevent complications from electrolyte shifts.