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A nurse is administering 4 mg of hydromorphone to a client by mouth every 4 hr. The medication is provided as hydromorphone 8 mg per tablet. Which of the following actions is appropriate for the nurse to take?

Return the remaining medication to the facility's pharmacy.

Dispose of the remaining ’edication while another nurse observes.

Store the remaining half of the pill in the automated medication dispensing system.

Place the remaining half of the pill in the unit-dose package.

None

Answer and Explanation

The Correct Answer is B

Answer: B. Dispose of the remaining medication while another nurse observes.

Rationale:

A) Return the remaining medication to the facility's pharmacy: Return the remaining medication to the facility's pharmacy: This is not typical practice for partial doses of controlled substances like hydromorphone. The pharmacy usually does not accept leftover portions of such medications.

B) Dispose of the remaining medication while another nurse observes: This is the correct and appropriate action. When administering controlled substances, any unused portion must be properly disposed of to prevent misuse or diversion. Having another nurse observe and document the disposal ensures accountability and adherence to safety protocols.

C) Store the remaining half of the pill in the automated medication dispensing system: Storing a partial tablet of a controlled substance is not appropriate. The automated medication dispensing system is designed to store and dispense whole doses of medication as prescribed. Storing partial tablets can lead to confusion, contamination, and potential misuse. It also increases the risk of medication errors, as the partial dose may not be easily identifiable or accurately accounted for.

D) Place the remaining half of the pill in the unit-dose package: his practice is not acceptable for controlled substances due to the risk of misuse, contamination, and the potential for medication errors. Controlled substances require strict handling and disposal procedures to ensure safety and compliance with regulatory standards. Placing a partial tablet back into the unit-dose package does not align with these standards and could lead to inappropriate use or administration.

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Correct Answer is C

Explanation

A) Increase in bowel function: Propofol is a sedative-hypnotic agent commonly used for induction and maintenance of anesthesia and sedation for procedures such as colonoscopies. While propofol may affect gastrointestinal motility, it typically leads to a decrease rather than an increase in bowel function. Therefore, an increase in bowel function would not be an expected adverse effect of propofol administration.

B) Increase in heart rate: Propofol generally has a depressant effect on the cardiovascular system, leading to a decrease rather than an increase in heart rate. It causes vasodilation and can result in hypotension and bradycardia, especially during induction of anesthesia. Therefore, an increase in heart rate would not be an expected adverse effect of propofol administration.

C) Decrease in respiratory rate: Respiratory depression is a well-known adverse effect of propofol. It acts as a potent central nervous system depressant, leading to dose-dependent respiratory depression. This effect is more pronounced when propofol is used for deeper levels of sedation or anesthesia. Therefore, monitoring for a decrease in respiratory rate is essential during and after propofol administration to prevent hypoxemia and respiratory compromise.

D) Decrease in body temperature: Propofol infusion syndrome (PRIS) is a rare but potentially fatal complication associated with prolonged high-dose propofol administration. Among its manifestations are metabolic acidosis, rhabdomyolysis, hyperlipidemia, and ultimately, multi-organ failure. However, a decrease in body temperature is not a characteristic feature of PRIS. Instead, hyperthermia or an increase in body temperature may occur as part of the syndrome. Therefore, monitoring for a decrease in body temperature is not a typical adverse effect of propofol administration.

A. Notify the nurse manager about the incident. B. Prepare and file an incident report. C. Notify the provider of the medication administration. D. Examine the client's vital signs and condition.

Correct Answer is D

Explanation

A) Notify the nurse manager about the incident: While it's important to report medication errors,’the immediate concern should be the client's well-being. Notifying the nurse manage’ can be done after addressing the client's condition.

B) Prepare and file an inc’dent report: Filing an incident report is necessary to document the error, but it should not be the first action taken. Ensuring the client's safety and well-being is the priority.’
C) Notify the provider of the medication administration: While it's important for the provider to be infor’ed of medication errors, the immediate concern should be assessing the client's response to the medication.

D) Examin’ the client's vital signs and condition: This is the’correct answer. The nurse's first action should be to assess the client's vital signs and condition to determine’any adverse effects of the medication. Digoxin is a medication used to treat heart conditions, but it can cause harm if administered when the heart rate is already low. Monitoring the client closely for signs of bradycardia or other adverse effects is essential.

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A nurse is administering 4 mg of hydromorphone to a client by mouth every 4 hr. The medication is provided as hydromorphone 8 mg per tablet. Which of the following actions is appropriate for the nurse to take?

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