A nurse is assessing a client 15 minutes after administering morphine sulfate 2 mg via IV push. The nurse should identify which of the following findings as an adverse effect of the medication?

Sleepy, but arousing when her name is called.

Respiratory rate 8/min.

Pain level of 6 on a scale from 0 to 10.

Answer and Explanation

The Correct Answer is B

Choice A reason:

Being sleepy but arousing when her name is called is a common side effect of morphine, which is a potent opioid analgesic. Morphine can cause drowsiness and sedation, but this is not necessarily an adverse effect unless it progresses to a state where the patient cannot be easily aroused. Therefore, while this is a side effect, it is not as concerning as respiratory depression.

Choice B reason:

A respiratory rate of 8/min is an adverse effect of morphine. Opioids like morphine can depress the respiratory center in the brain, leading to a decreased respiratory rate. Normal respiratory rates for adults are typically between 12 and 20 breaths per minute. A rate of 8 breaths per minute indicates significant respiratory depression, which can be life-threatening and requires immediate intervention.

Choice C reason:

A pain level of 6 on a scale from 0 to 10 indicates that the morphine has not fully alleviated the client’s pain. While this is important to address, it is not an adverse effect of the medication. The primary concern with morphine administration is monitoring for serious side effects like respiratory depression.

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Correct Answer is C

Explanation

Choice A reason: Activate the patch 30 minutes after application

This statement is incorrect. The transdermal sumatriptan patch should be activated immediately after application, not 30 minutes later. The patch uses a mild electrical current to deliver the medication through the skin, and delaying activation would reduce its effectiveness.

Choice B reason: Take this medication daily to prevent headaches

This statement is also incorrect. Sumatriptan is used to treat acute migraine attacks and is not intended for daily use to prevent headaches. It should be used only when a migraine begins. Daily use could lead to medication overuse headaches and other side effects.

Choice C reason: Use contraception while taking this medication

This statement is correct. Women of childbearing age should use contraception while taking sumatriptan because its safety during pregnancy has not been established. It is important to avoid potential risks to the fetus.

Choice D reason: You can bathe with the patch in place

This statement is correct. The transdermal sumatriptan patch is designed to stay in place during bathing, showering, or swimming. However, it is not the most critical piece of information compared to the need for contraception.

A. Long attention span B. Delayed language development C. Speaking with direct eye contact D. Repetitive behavior E. Playing with toys repetitively

Correct Answer is ["B","D","E"]

Explanation

Choice A reason:

The statement “Long attention span” is generally not associated with autism spectrum disorder (ASD). Children with ASD often have difficulty maintaining attention on tasks or activities, especially those that do not interest them. They may exhibit hyperfocus on specific interests but typically struggle with sustained attention in other areas.

Choice B reason:

The statement “Delayed language development” is a common characteristic of ASD. Many children with autism experience delays in speech and language skills. They may have difficulty with verbal communication, understanding language, and using language in social contexts. This delay can vary widely among individuals with ASD.

Choice C reason:

The statement “Speaking with direct eye contact” is not typically associated with ASD. Children with autism often avoid direct eye contact and may find it uncomfortable or overwhelming. They might look away or use peripheral vision instead of making direct eye contact during conversations.

Choice D reason:

The statement “Repetitive behavior” is a hallmark of ASD. Children with autism often engage in repetitive behaviors, such as hand-flapping, rocking, or repeating certain actions or phrases. These behaviors can be a way to self-soothe or cope with sensory overload.

Choice E reason:

The statement “Playing with toys repetitively” is also characteristic of ASD. Children with autism may play with toys in a repetitive manner, such as lining them up, spinning them, or focusing on specific parts of the toy rather than using them in imaginative play. This repetitive play is part of the broader pattern of repetitive behaviors seen in ASD.

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A nurse is assessing a client 15 minutes after administering morphine sulfate 2 mg via IV push. The nurse should identify which of the following findings as an adverse effect of the medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a female client who has a new prescription for transdermal sumatriptan to treat migraine headaches. Which of the following instructions should the nurse include?

Correct Answer is C

Explanation

A nurse is caring for a child who has autism spectrum disorder. Which of the following findings should the nurse expect? (Select all that apply.)

Correct Answer is ["B","D","E"]

Explanation

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