A nurse is preparing to administer morphine 30 mg oral suspension to a client. The amount available is morphine 100 mg/5mL oral solution. How many mi should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Rationale for correct choices

• Compartment syndrome: The adolescent demonstrates escalating pain despite repeated opioid administration, along with moderate edema, delayed capillary refill, and numbness/tingling in the affected limb. These signs indicate increased pressure within the casted compartment, which can compromise circulation and nerve function.

• Increasing capillary refill times: Capillary refill has lengthened from 3 to 4 seconds, suggesting impaired peripheral perfusion in the affected extremity. This change indicates vascular compromise and aligns with the pathophysiology of compartment syndrome. Monitoring these subtle vascular changes helps identify early ischemia before permanent damage occurs.

Rationale for incorrect choices

• Pneumonia: Shallow respirations and a slightly increased respiratory rate are present but are mild and likely related to pain or anxiety. Breath sounds remain clear, and oxygen saturation is slightly decreased but not critically low. There is no productive cough, fever spikes, or infection in the lungs, making pneumonia less likely.

• Infection: While the adolescent’s temperature has risen slightly, there is no redness, drainage, or local signs at the surgical site. White blood cell counts are not provided, and systemic signs of infection are minimal. The mild fever could be due to stress or inflammation from surgery rather than infection. Current symptoms points toward neurovascular compromise rather than infection.

• Shallow respirations: Although respirations are shallow at times, this finding alone is more consistent with pain or guarding from the femur injury than with a systemic complication. Respiratory assessment does not demonstrate adventitious sounds or significant hypoxia. Shallow breathing is not the primary indicator of compartment syndrome.

• Increasing respiratory rate: The rise in respiratory rate is minor and likely a response to pain, stress, or mild hypoxia, not the early sign of compartment syndrome. Tachypnea without other systemic signs does not reliably indicate limb vascular compromise. While important to monitor, it is not specific to the identified risk.

A. Administer methylphenidate daily: Stimulant medications like methylphenidate are not appropriate for anorexia nervosa treatment, as they can suppress appetite and worsen weight loss. They are contraindicated in clients with this disorder.

B. Weigh the client twice a week: Weighing twice a week is insufficient for clients with anorexia nervosa. Daily, same-time, same-clothing weights are recommended to monitor progress and detect potential medical complications associated with malnutrition.

C. Focus conversations around food at mealtimes: Focusing on food can increase anxiety and reinforce preoccupations with eating. Instead, conversations should be neutral or supportive, promoting a calm and therapeutic mealtime environment.

D. Inform the client of the specific duration of meals: Setting clear expectations for meal duration helps reduce anxiety, provides structure, and supports adherence to nutritional rehabilitation. It is an effective intervention in the care plan for clients with anorexia nervosa.