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Administering an additional dose of morphine sulfate 2 mg IV is unsafe because the client received the medication only one hour ago, and the prescription specifies administration every 4 hours PRN. Giving another dose before the prescribed interval could result in oversedation, respiratory depression, or other opioid-related adverse effects. Nurses must adhere to prescribed dosing intervals unless the provider modifies the order. Therefore, this option is incorrect because it violates safe medication administration principles.

Reviewing the medical record for additional pain medication prescriptions is a reasonable step but not the immediate priority. While multimodal pain management is often used (e.g., combining opioids with non-opioid analgesics or adjuvant medications), the nurse must first address the acute situation of uncontrolled severe pain. Checking the record may reveal other options, but since the client is already in distress, the most urgent action is to contact the provider for reassessment and possible adjustment of the opioid regimen. This option alone does not directly resolve the client’s current pain crisis.

Encouraging the client to allow more time for the medication to work is inappropriate because morphine sulfate IV should have already reached peak effect within 20 minutes. One hour after administration, the client should be experiencing significant relief. Telling the client to wait longer disregards the pharmacokinetics of the drug and fails to address the fact that the pain remains at the highest level possible. This response minimizes the client’s report and delays necessary intervention, which could worsen suffering and compromise trust in care.

Prednisone is a corticosteroid used for inflammatory conditions such as osteoarthritis. While long-term use of corticosteroids can cause multiple systemic side effects such as immunosuppression, osteoporosis, and hyperglycemia, jaundice is not a typical direct adverse effect of prednisone. Hepatic dysfunction is not commonly associated with prednisone use, so this medication is not the most concerning in the context of jaundice.

Omeprazole is a proton pump inhibitor used for gastroesophageal reflux disease. Its adverse effects are generally related to gastrointestinal symptoms, vitamin B12 deficiency, or increased risk of infections such as Clostridium difficile. Hepatotoxicity is rare with omeprazole, and jaundice is not a common manifestation of its side effects. Therefore, omeprazole is not the medication that requires urgent notification to the healthcare provider in this scenario.

Captopril is an ACE inhibitor used for hypertension. Its common adverse effects include cough, hyperkalemia, hypotension, and angioedema. Hepatic dysfunction is not a typical adverse effect of captopril, and jaundice is not directly associated with its use. Thus, captopril is not the medication of concern in this case.

Telling the client that sometimes clients feel like the TV is sending them messages is inappropriate because it introduces the idea of psychotic symptoms that the client may not be experiencing. This could confuse or distress the client and does not provide therapeutic support.

Explaining that watching TV is passive and the goal is to encourage activity is partially true, but it is not the most therapeutic response. It focuses on the nurse’s perspective rather than addressing the client’s concern in a supportive and empathetic way.

Allowing the client to watch TV as much as they want outside the room does not encourage therapeutic engagement. While it acknowledges the availability of TV, it does not promote active participation in treatment or social interaction, which are essential for clients with depression.

Reporting COVID-19 results to the local health department is an important public health measure, but it is not the most immediate priority at this stage. The nurse has not yet received the test results, and reporting is only required once a positive result is confirmed. While this action is necessary for surveillance and contact tracing, it does not address the immediate need to protect healthcare workers and other patients from potential exposure.

Explaining to the client that they should inform others of potential exposure is appropriate, but it is not the most urgent intervention. While contact tracing and notifying close contacts are important for community safety, the nurse’s immediate responsibility is to protect themselves and others in the healthcare setting. This action can be addressed later once the diagnosis is confirmed and public health measures are initiated.

Teaching the client to wear a mask, hand wash, and social distance is an essential part of patient education, but it is not the most immediate priority in the emergency department setting. The client is already in a healthcare facility, and the nurse must first ensure proper PPE use to prevent direct transmission. Education about preventive measures is important for long-term management, but infection control through PPE is the most critical step at this moment.

Applying oxygen via nasal cannula is appropriate if the child is hypoxic, but oxygen therapy does not directly prevent sickling unless hypoxemia is present. Oxygen can help relieve symptoms and improve tissue oxygenation, but hydration is the priority because it directly reduces the risk of vaso-occlusion. Oxygen is supportive but not the first-line intervention in this scenario.

Administering pain medication is essential for managing the severe pain associated with vaso-occlusive crises. However, pain control does not prevent the crisis itself. Pain management is important for comfort and quality of life, but the priority intervention to minimize crisis development is hydration. Pain medication should follow after stabilization measures.

Determining tolerance of activity is part of ongoing assessment but is not the immediate priority. Limiting strenuous activity is important because exertion can increase oxygen demand and worsen sickling, but this is secondary to ensuring hydration. Activity tolerance assessment is supportive but not the first action to minimize crisis risk.

Informing the healthcare provider of HbA1C results weekly is incorrect because HbA1C is not measured daily or weekly. HbA1C reflects average blood glucose levels over 2–3 months and is typically checked every 3–6 months in a clinical setting. The client does not self-monitor HbA1C at home, so this statement shows misunderstanding.

Using a lancing device on the center of the finger pad is incorrect because the center of the finger pad is more sensitive and painful. The recommended site is the side of the fingertip, which is less painful and still provides adequate blood flow for testing. This statement demonstrates improper technique.

Documenting HbA1C results from the SMBG monitor every morning is inaccurate because SMBG monitors measure daily glucose levels, not HbA1C. HbA1C requires laboratory testing and cannot be obtained from a home glucose monitor. This statement reflects confusion between daily glucose monitoring and long-term glycemic control.

Determining the need for urinary catheterization requires assessment and clinical judgment, which are responsibilities of the RN. PNs can perform catheterization once ordered, but they cannot independently determine the need for the procedure. Therefore, this task is inappropriate to delegate to a PN.

Initiating teaching for client care after discharge is an RN responsibility because it involves patient education, assessment of learning needs, and evaluation of understanding. Teaching requires advanced knowledge and accountability, which are outside the PN’s scope of practice.

Completing comprehensive assessments is an RN responsibility because it involves synthesizing data, identifying problems, and planning care. PNs can contribute to data collection but cannot perform or interpret comprehensive assessments independently.

Checking respiratory rate and lung sounds is important for overall assessment, but it does not directly determine feeding safety. While abnormal lung sounds may suggest aspiration risk, the immediate priority before feeding is to evaluate swallowing ability. Respiratory assessment is supportive but not the most critical step in this context.

Reviewing the consistency of the prescribed diet is necessary to ensure the client receives the correct nutrition (e.g., pureed, soft, or liquid diet). However, this step comes after confirming the client’s ability to chew and swallow safely. If the client cannot swallow properly, even the prescribed diet consistency may pose a risk.

Reviewing current medications is important for understanding side effects that may affect appetite, swallowing, or alertness. However, this is not the most immediate priority before feeding. The nurse must first ensure the client can safely chew and swallow food to prevent aspiration.

A decreased blood urea nitrogen (BUN) is not typically associated with gentamicin toxicity. Gentamicin can cause nephrotoxicity, which would lead to increased BUN and creatinine levels, not decreased. Therefore, this finding does not indicate an adverse effect of gentamicin.

Photophobia is sensitivity to light and is not a recognized adverse effect of gentamicin. It may occur with other conditions or medications but is not related to aminoglycoside toxicity. This observation is not relevant to gentamicin use.

A white blood cell count of 6,000/mm³ is within the normal reference range (5,000–10,000/mm³). This finding does not indicate an adverse effect of gentamicin. Normal WBC levels suggest no hematologic toxicity or infection-related complication.