A nurse is caring for a client who is receiving morphine intravenously. Which of the following findings indicates the client is experiencing morphine toxicity?

Rationale for Correct Choices:

• Seizures: The client presents with severe preeclampsia, indicated by BP >160/110 mm Hg, 3+ proteinuria, hyperreflexia (patellar reflex 4+), and persistent headache. These are strong predictors of progression to eclampsia, which is marked by seizures.
• Placental Abruption: Severe hypertension increases the risk of placental abruption due to vascular compromise in the uteroplacental circulation. Decreased fetal movement may be an early warning sign of impaired placental perfusion or separation.

Rationale for Incorrect Choices:

• Cervical Insufficiency: This is a painless cervical dilation often leading to second-trimester loss, unrelated to hypertension or proteinuria. The client is in the third trimester with no signs of cervical changes.
• Hypoglycemia: The client has no history of diabetes, glucose intolerance, or related symptoms. Her urine glucose was only trace, and no medications suggest insulin use.
• Heart Failure: No signs of pulmonary congestion, dyspnea, or elevated heart rate are present. Oxygen saturation is normal, and breath sounds are not mentioned as abnormal, making CHF unlikely at this stage.

Rationale:

A. "I should avoid over-the-counter medications that contain alcohol.": Disulfiram causes an unpleasant reaction when alcohol is consumed, even in small amounts. Clients must avoid alcohol-containing products such as certain cough syrups, mouthwashes, and topical solutions to prevent serious adverse effects like flushing, nausea, and hypotension.

B. "I will need to get a monthly injection of this medication.": Disulfiram is an oral medication taken daily, not administered via monthly injection. The injectable form is associated with other medications used in substance use disorder treatment, such as naltrexone.

C. "My provider wants me to take this medication for 2 weeks before I try to quit drinking.": Disulfiram is intended for clients who have already stopped drinking. It is not used to initiate abstinence but to maintain it by discouraging alcohol use through aversive effects.

D. "I will plan to continue taking this medication for at least 5 years.": The duration of disulfiram therapy varies based on the client’s progress and treatment plan. Long-term use beyond 1–2 years is uncommon and typically guided by continued risk of relapse and provider judgment.