A 65-year-old woman with no history of pulmonary or cardiovascular issues presents to the emergency department with nausea, fatigue, and fullness and pain of the abdomen. The nurse knows the assessment tests that will be ordered first will include:

Choice A reason:
Morphine is not most effective when given orally due to the high first-pass effect. The first-pass effect refers to the metabolism of a drug in the liver immediately after it enters the bloodstream from the gastrointestinal tract, significantly reducing the amount of active drug that reaches systemic circulation. Therefore, oral administration of morphine is not the most effective route because much of it is metabolized before it can exert its effect.

Choice B reason:
Morphine will be more effective when given via a non-enteral route such as intravenous (IV) or subcutaneous (SQ) because these routes bypass the liver, thereby avoiding the first-pass metabolism. This allows a higher concentration of the active drug to reach the systemic circulation, providing a more potent and effective pain relief.

Choice C reason:
Oral and IV administration of morphine do not have the same effect due to the first-pass metabolism. When morphine is administered orally, a significant amount is metabolized by the liver before it reaches the systemic circulation, whereas IV administration delivers the drug directly into the bloodstream, bypassing the liver and allowing a higher active concentration.

Choice D reason:
Morphine is not primarily excreted by the lungs; it is mainly metabolized by the liver and excreted by the kidneys. This statement does not accurately demonstrate an understanding of the first-pass effect or the pharmacokinetics of morphine.

Choice A reason:
Maintaining a healthy lifestyle and avoiding high-fat foods is appropriate advice. Statins are more effective when combined with a healthy diet and lifestyle. This helps in managing cholesterol levels and reducing the risk of cardiovascular events.

Choice B reason:
The statement that muscle pain is not concerning with statin use is inappropriate. Muscle pain can be a significant side effect of statins, known as myopathy, and in rare cases, it can lead to a more severe condition called rhabdomyolysis. Patients experiencing muscle pain should report it to their healthcare provider for evaluation and management.

Choice C reason:
Statins do reduce the risk of coronary events in people with diabetes and slightly elevated LDL levels. This is well-documented and an appropriate part of patient education, as statins are beneficial in preventing cardiovascular events in at-risk populations.

Choice D reason:
Statin use can cause gastrointestinal (GI) side effects, including nausea, constipation, and diarrhea. This information should be part of patient education so that patients are aware of potential side effects and can manage them appropriately.