A nurse is reinforcing teaching with a newly licensed nurse about monitoring morphine patient-controlled analgesia (PCA). Which of the following information should the nurse include?

"Using morphine PCA increases the client's risk of toxicity.”

"Diarrhea is an adverse effect of morphine PCA.”

"Check the client's pain level every 8 hours.”

"Instruct the client's visitors not to operate the PCA pump.”

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Using PCA does not necessarily increase the client’s risk of toxicity. PCA allows the client to self-administer preset doses of pain medication, which can lead to better pain control with less risk of overdose.

Choice B rationale:

Diarrhea is not a common adverse effect of morphine. Constipation, not diarrhea, is a common side effect due to slowed gastrointestinal motility.

Choice C rationale:

Checking the client’s pain level every 8 hours is not sufficient when using PCA. Pain levels should be assessed more frequently, ideally before and after each administration of the medication. This allows for timely adjustments to the medication regimen if needed.

Choice D rationale:

Instructing the client’s visitors not to operate the PCA pump is crucial. Only the patient should administer doses to prevent overdose.

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Correct Answer is A

Explanation

Choice A rationale:

Hoarseness of voice can be a symptom of an allergic reaction, indicating swelling and inflammation in the throat. If the client’s voice is no longer hoarse after taking diphenhydramine, it suggests that the medication has been effective in reducing this symptom.

Choice B rationale:

Diphenhydramine is an antihistamine and can often cause drowsiness as a side effect. Therefore, feeling more alert would not typically indicate that the medication has been effective.

Choice C rationale:

While headaches can sometimes be associated with allergic reactions, they are not a primary symptom that diphenhydramine targets. Therefore, absence of a headache does not necessarily indicate effectiveness of the medication.

Choice D rationale:

Increased appetite is not typically associated with the effectiveness of diphenhydramine in treating allergic reactions.

A. Fish oil supplements. B. Calcium supplements. C. Bulk-forming laxatives. D. Oral antihistamines.

Correct Answer is B

Explanation

Choice A rationale:

Fish oil supplements do not have a known interaction with levothyroxine.

Choice B rationale:

Calcium supplements can interfere with the absorption of levothyroxine. They should be taken at least four hours apart from levothyroxine.

Choice C rationale:

While bulk-forming laxatives can interfere with the absorption of some medications, there’s no specific evidence they interfere with levothyroxine.

Choice D rationale:

Oral antihistamines do not have a known interaction with levothyroxine.

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A nurse is reinforcing teaching with a newly licensed nurse about monitoring morphine patient-controlled analgesia (PCA). Which of the following information should the nurse include?

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