The nurse admits a client with a diagnosis of stage 4 cancer. The client has a prescription to wear a subcutaneous morphine sulfate patch for pain. The client is short of breath and difficult to arouse.
While performing a head-to-toe assessment, the nurse discovers four patches on the client’s body. Which action should the nurse take first?
Remove the morphine patches.
Monitor blood pressure.
Apply oxygen face mask.
Administer a narcotic reversal drug.
The Correct Answer is A
The client’s symptoms of being short of breath and difficult to arouse may indicate an overdose of morphine. The nurse should immediately remove the patches to prevent further absorption of the drug. After removing the patches, the nurse should continue to assess the client’s condition and take further actions as needed, such as administering a narcotic reversal drug or providing oxygen.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D"]
Explanation
The correct answer is:
a. Report any tendon pain or swelling to the healthcare provider immediately.
d. Limit exposure to sunlight and avoid tanning beds.
Choice A: Report any tendon pain or swelling to the healthcare provider immediately.
Ciprofloxacin, like other fluoroquinolones, can cause tendinitis and tendon rupture. This risk is higher in older adults, those on corticosteroid therapy, and those with kidney, heart, or lung transplants. Reporting any tendon pain or swelling immediately is crucial to prevent severe complications.
Choice B: Use NSAIDS to relieve mid joint aches and pains caused by the medication.
This is not recommended. Using NSAIDs with ciprofloxacin can increase the risk of central nervous system effects, including seizures. Therefore, it is not advised to use NSAIDs to relieve joint aches and pains caused by ciprofloxacin.
Choice C: Crush and mix the tablets with pudding if you have trouble swallowing the tablets.
Ciprofloxacin tablets should not be crushed. Crushing the tablets can affect the drug’s effectiveness and increase the risk of side effects. If swallowing is an issue, the healthcare provider should be consulted for alternative forms of the medication.
Choice D: Limit exposure to sunlight and avoid tanning beds.
Ciprofloxacin can increase the skin’s sensitivity to sunlight, leading to severe sunburns. Patients are advised to limit their exposure to sunlight and avoid tanning beds while taking this medication.
Correct Answer is A
Explanation
The client’s symptoms of being short of breath and difficult to arouse may indicate an overdose of morphine. The nurse should immediately remove the patches to prevent further absorption of the drug. After removing the patches, the nurse should continue to assess the client’s condition and take further actions as needed, such as administering a narcotic reversal drug or providing oxygen.
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