The nurse is caring for a patient who has diabetes and complains of chronic, burning leg pain even when taking oxycodone (OxyContin) twice daily. Which prescribed medication is the best choice for the nurse to administer as an adjuvant to decrease the patient's pain?

Choice A reason: Patient stopped taking the medication 2 days ago is the most important information to report to the health care provider. Prednisone is a corticosteroid medication that suppresses the immune system and reduces inflammation. Prednisone also affects the production of cortisol, a hormone that regulates the stress response, blood pressure, blood sugar, and metabolism. Prednisone should not be stopped abruptly, as this can cause adrenal insufficiency, a condition where the adrenal glands cannot produce enough cortisol. Adrenal insufficiency can cause symptoms such as fatigue, weakness, nausea, vomiting, low blood pressure, and hypoglycemia. The patient should be instructed to resume taking the prednisone and taper the dose gradually under the supervision of the health care provider.

Choice B reason: Patient has not been taking the prescribed vitamin D is not as important as choice A, but still requires further education by the nurse. Vitamin D is a fat-soluble vitamin that helps the body absorb calcium and phosphorus, and maintain bone health. Prednisone can interfere with the metabolism of vitamin D and cause bone loss, osteoporosis, and fractures. The patient should be advised to take the prescribed vitamin D supplement and eat foods rich in vitamin D, such as fatty fish, egg yolks, cheese, and fortified milk.

Choice C reason: Patient has bilateral 2+ pitting ankle edema is not as critical as choice A, but still needs to be monitored by the nurse. Ankle edema is swelling of the ankles due to fluid accumulation in the tissues. Prednisone can cause ankle edema by increasing the sodium and water retention in the body, and reducing the potassium excretion by the kidneys. The patient should be assessed for signs of fluid overload, such as weight gain, shortness of breath, and crackles in the lungs. The patient should also be encouraged to limit the intake of salt and fluids, and elevate the legs when sitting or lying down.

Choice D reason: Patient's blood pressure is 148/94 mm Hg is not as urgent as choice A, but still needs to be addressed by the nurse. Blood pressure is the force of blood against the walls of the arteries. Prednisone can increase the blood pressure by stimulating the renin-angiotensin-aldosterone system, a hormonal system that regulates the blood volume and pressure. The patient should be advised to check the blood pressure regularly, and report any readings above 140/90 mm Hg to the health care provider. The patient should also be counseled to follow a healthy lifestyle, such as exercising, quitting smoking, reducing stress, and eating a balanced diet low in sodium, fat, and cholesterol.

The nurse should administer 1.4 mL of Heparin to the patient.

To calculate the number of milliliters (mL) the nurse should administer, we can use the following steps:

Step 1: Calculate the total amount of Heparin available in mL

Heparin concentration: 5,000 units per mL

Ordered Heparin dose: 7,000 units

Total mL of Heparin needed = Ordered dose / Heparin concentration

Total mL = 7,000 units / 5,000 units per mL = 1.4 mL