A nurse is caring for a client who will undergo a procedure. The client states he does not want the provider to discuss the results with his partner. Which of the following is an appropriate response for the nurse to make?

Rationale:

A. Provide the child with electronics to watch movies: While distraction can be helpful in managing anxiety or discomfort, it does not directly address the child’s feelings about hair loss. Emotional support specific to the child’s concern is more appropriate in this situation.

B. Tell the child there's no need to cry because this is expected: Minimizing the child’s feelings invalidates their emotional experience and can increase distress. Acknowledging and supporting the child’s emotions is essential for coping during hair loss caused by radiation therapy.

C. Provide the child with a doll that does not have any hair: Giving a doll without hair helps the child normalize hair loss and provides a concrete way to express and cope with feelings. This action demonstrates understanding, empathy, and age-appropriate support for the child’s emotional needs.

D. Tell the child not to worry about their hair loss because their hair will grow back: While it is true that hair often regrows after treatment, reassurance alone does not address the child’s immediate emotional reaction. Supporting the child’s feelings and providing relatable coping strategies is more effective.

Rationale:

A. Bradypnea: Respiratory depression is the most serious and potentially life-threatening adverse effect of morphine, especially after IV administration when onset is rapid. Bradypnea indicates a compromised airway and inadequate ventilation, making it the nurse’s priority for immediate assessment and intervention to prevent hypoxia and respiratory arrest.

B. Sedation: Sedation is a common effect of morphine and requires monitoring, but it is less immediately dangerous than respiratory depression. The nurse should assess the depth of sedation and level of consciousness while ensuring airway safety.

C. Constipation: Constipation is a common long-term side effect of opioids, but it is not an immediate threat to life. Preventive measures can be planned, but it does not take priority over acute respiratory compromise.

D. Euphoria: Euphoria may occur with opioid administration and is generally not harmful in the short term. While the nurse should monitor for behavioral changes or signs of misuse, it does not pose an immediate risk compared with respiratory depression.