A nurse is reviewing medication prescriptions for a client. For which of the following entries on the client's medication administration record should the nurse request clarification?

Simvastatin 40 mg PO at bedtime

Morphine 4 mg IV every 4 hr PRN for pain

Levothyroxine 100 mcg PO every morning

Acetaminophen 500 mg every 4 hr PRN for fever

Answer and Explanation

The Correct Answer is B

A. Simvastatin 40 mg PO at bedtime: This prescription is clear and specifies the medication (Simvastatin), the dose (40 mg), route (PO – oral), and timing (at bedtime). There is no need for clarification.
B. Morphine 4 mg IV every 4 hr PRN for pain: The need for clarification arises here because "PRN" (pro re nata) means "as needed," and prescribing an IV medication on an as-needed basis might need further clarification regarding the specific indications and circumstances for administering the medication.
C. Levothyroxine 100 mcg PO every morning: This prescription is clear and specifies the medication (Levothyroxine), the dose (100 mcg), route (PO – oral), and timing (every morning). There is no need for clarification.
D. Acetaminophen 500 mg every 4 hr PRN for fever: Similar to option B, there might be a need for clarification regarding the specific indications and circumstances for administering acetaminophen on an as-needed basis. However, in many cases, PRN for fever is reasonable, so it may not be as critical as in the case of an IV pain medication.

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Correct Answer is D

Explanation

A. Acetaminophen: This is a common pain reliever and fever reducer. Acetaminophen is often used alongside other medications, including opioids like morphine, to manage pain more effectively. It's typically safe to use with morphine and is not an immediate concern for clarification.

B. Insulin glargine: Insulin glargine is a long-acting insulin used to control blood sugar levels in individuals with diabetes. While it's important to monitor blood sugar levels in patients receiving opioids, especially if they have diabetes, insulin glargine itself doesn't directly interact with morphine or the PCA pump.

C. Ondansetron: Ondansetron is an anti-nausea medication commonly used to prevent nausea and vomiting, particularly associated with chemotherapy or surgery. Patients receiving morphine, especially those with cancer, may also be prone to nausea. Ondansetron helps manage this side effect and does not typically interact adversely with morphine.

D. Naloxone: Naloxone is an opioid antagonist used to rapidly reverse the effects of opioid overdose, including respiratory depression, caused by drugs like morphine. It's administered in emergency situations to counteract the potentially life-threatening effects of opioids. While naloxone is critical for opioid safety, its presence on the medication list requires clear understanding and specific instructions regarding its use, dosage, and administration protocols in case of opioid-related emergencies.

A. Discard the medication if it is yellow. B. Administer the medication over 2 hr. C. Prime the tubing with 0.9% sodium chloride D. Use a gravity flow set

Correct Answer is C

Explanation

A. Discard the medication if it is yellow: Amphotericin B lipid complex is typically yellow in color. This is a normal characteristic of the medication, and it should not be discarded based on color. The nurse should be aware of the expected color and administer the medication as prescribed.
B. Administer the medication over 2 hr: Amphotericin B lipid complex is often administered over an extended period (usually over 2 to 6 hours) to minimize the risk of infusion-related reactions. However, if the prescription specifies an intermittent IV bolus, the nurse should follow the prescribed administration route and rate.
C. Prime the tubing with 0.9% sodium chloride (Correct Answer): Amphotericin B lipid complex can interact with dextrose-containing solutions, leading to the formation of a precipitate. Therefore, it is recommended to prime the IV tubing with 0.9% sodium chloride before administering the medication to prevent any potential interaction.
D. Use a gravity flow set: The choice of infusion set may depend on the specific institutional policies and the patient's condition. However, using a pump or a controlled infusion device is often recommended when administering medications like amphotericin B to ensure accurate infusion rates and reduce the risk of adverse reactions.

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A nurse is reviewing medication prescriptions for a client. For which of the following entries on the client's medication administration record should the nurse request clarification?

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