When preparing to administer an intravenous medication through a client's triple lumen central venous catheter, the nurse observes that there are no continuous intravenous fluids infusing. Which action should the nurse take?

A. Obtain blood glucose level: The first step is to check the client’s blood glucose so the correct insulin dose can be determined according to the sliding scale prescription. Without this value, safe and accurate dosing cannot be achieved.

B. Draw insulin into insulin syringe: After verifying the prescription, the correct amount of insulin is drawn up. This ensures accuracy and avoids delays once the injection site has been prepared, maintaining sterility and efficiency.

C. Verify the insulin prescription: Before drawing up the insulin, the nurse or client must compare the blood glucose result with the sliding scale prescription to determine the exact dose required. This prevents medication errors and ensures correct administration.

D. Cleanse the selected site: The last step before injection is cleansing the skin with an alcohol swab. This minimizes infection risk and prepares the area for insulin administration after the correct dose has been measured.

Rationale for correct choices:

• Respirations: Morphine is an opioid analgesic that can depress the respiratory center in the brainstem, leading to slowed breathing and hypoventilation. Monitoring respirations after administration is critical to detect early signs of opioid-induced respiratory depression.

• Ice application to the shoulder: Applying ice reduces swelling, pain, and inflammation by causing vasoconstriction and limiting fluid accumulation at the injury site. For an acute humeral fracture with significant swelling and bruising, cold therapy is the appropriate intervention.

Rationale for incorrect choices:

• Nausea: While morphine can cause nausea and vomiting as side effects, they are not the most life-threatening concerns compared to respiratory depression. Monitoring nausea is appropriate but not the priority when evaluating opioid safety.

• Blood pressure: Morphine can cause hypotension, but this effect is less common and typically secondary to respiratory depression and vasodilation. Continuous monitoring of blood pressure is helpful, but respiratory monitoring takes priority in detecting opioid complications.

• Early active range of motion: Active movement of the injured arm is not recommended immediately after a displaced humeral fracture, as it can worsen displacement and interfere with healing. Immobilization and stabilization are required before introducing range-of-motion exercises.

• Heat application to the shoulder: Heat increases blood flow to tissues, which can worsen swelling and bleeding in the acute phase of injury. Applying heat too soon after a fracture increases the risk of complications rather than reducing them.