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The client is a 42-year-old female who had a right above-the- knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1. What actions should the nurse take to assure safety morphine administration? Select all that apply.

A.

Suction the client to clear the airway

B.

Restrain the client with soft restraints

C.

Perform a 12-lead electrocardiogram

D.

Have a manual resuscitation bag at the bedside

E.

Ask the client about other medications she takes

F.

Take an initial respiratory rate

Answer and Explanation

Correct Answer : E,F

A. Suctioning the client to clear the airway is not directly related to the administration of morphine and is typically not a routine precaution unless the patient has a specific need.
B. Using soft restraints is not a standard safety measure for morphine administration and could be considered if the patient has a history of confusion or agitation, but there is no such indication in this scenario.
C. Performing a 12-lead electrocardiogram is not a standard procedure for ensuring the safe administration of morphine and is usually done for cardiac assessment.
D. Having a manual resuscitation bag at the bedside is a good practice in case of an emergency but is not specific to morphine administration safety.
E. Asking the client about other medications she takes is crucial to prevent drug interactions, as morphine can interact with many medications, potentially leading to adverse effects.
F. Taking an initial respiratory rate is important because morphine can cause respiratory depression, and it is essential to have a baseline to monitor for any changes after administration.
 


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Related Questions

Correct Answer is D

Explanation

A. Marking the outline of the "olive-shaped" mass is important for diagnosis but is not the highest priority in pre-operative care.
B. Instructing parents regarding care of the incisional area is important but not the highest priority before surgery.
C.Monitoring feedings is important, but the primary concern is ensuring hydration and electrolyte balance, which may be compromised due to vomiting in pyloric stenosis.


D. IV fluids are essential to correct dehydration and electrolyte imbalances caused by vomiting in pyloric stenosis. This is the highest priority to stabilize the infant before surgery.

Correct Answer is ["8"]

Explanation

Given:

IV solution contains 100 units of regular insulin in 100 mL of 0.9% normal saline.

The prescribed rate is 8 units/hr.

First, we find out how many units are present in 1 mL of the IV solution: 100 units / 100 mL = 1 unit / 1 mL

Now, since the prescribed rate is 8 units/hr, we need to infuse 8 mL/hr of the IV solution to deliver 8 units of insulin per hour.

So, the nurse should program the infusion pump to deliver 8 mL/hr.

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