A client is newly prescribed calcium carbonate and asks how they should take this medication. What is the best response by the nurse?

A) Evaluation: Evaluation is the phase where the nurse assesses whether the goals or outcomes of the care plan have been met. It involves determining if the interventions provided were effective in achieving the desired outcomes. In this scenario, the nurse is still
gathering information before the action is taken, so evaluation is not the correct phase.

B) Planning: Planning is the phase in the nursing process where the nurse develops a care plan, which includes setting goals and determining interventions based on the client's needs. Although reviewing the medical record and blood glucose level is important for planning the administration of insulin, this is more about gathering data rather than forming a plan of care.

C) Implementation: Implementation refers to the actual delivery of the nursing interventions or actions. In this case, administering the insulin would be part of the implementation phase, but reviewing the medical history and obtaining a fingerstick blood glucose reading are steps taken before implementing the medication.

D) Assessment: The nurse is collecting pertinent information about the client’s condition, including reviewing the medical record and obtaining the blood glucose level. Assessment is the first step in the nursing process and involves gathering information to help guide clinical decisions.

E) Diagnosis: Diagnosis is the phase in which the nurse analyzes the assessment data to identify the client’s health problems or potential risks. While the nurse is collecting data, the diagnosis comes after the assessment phase, when the nurse has enough information to make a clinical judgment about the client's health status.

A) Opioid drugs are highly addictive, and the healthcare provider is concerned you will become addicted: While it is true that opioids have the potential for addiction, this response does not address the actual reason for the difference in morphine dosages. The provider's decision is likely based on the pharmacokinetics of the drug rather than a concern about addiction. This response could create unnecessary concern for the client and does not explain the dose discrepancy.

B) Morphine is highly bound to protein in your blood, and you are at risk for toxicity due to surgery: While morphine is protein-bound, the primary reason for the difference in the intravenous (IV) dose is not related to protein binding. The main difference is related to the route of administration and how the body processes the drug. The nurse should provide a more accurate explanation regarding the absorption and metabolism of morphine rather than focusing on protein binding or potential toxicity.

C) "Morphine taken by mouth passes through the liver, and some of the medication is made inactive": This is the best response. When morphine is taken orally, it is absorbed into the bloodstream and passes through the liver before reaching systemic circulation, a process known as the "first-pass effect." During this process, a portion of the drug is metabolized and rendered inactive, meaning that a higher oral dose is required to achieve the desired effect. When morphine is administered intravenously, it bypasses the liver and directly enters the bloodstream, leading to a more immediate and potent effect, which is why a lower dose is needed.

D) "The healthcare provider is cautious with opioids and starts low and adjusts the dose up as needed": While this is a valid approach to opioid prescribing, it doesn't fully explain why the client is receiving a smaller dose intravenously. The reason for the dose difference is based on the route of administration and the pharmacokinetic properties of the drug, not just a general cautious approach. This answer doesn't provide a clear explanation of why the IV dose is smaller.