A nurse is caring for a client whose current bag of total parenteral nutrition (TPN) has finished infusing, and the next bag is not yet available. Which of the following fluids should the nurse prepare to administer?

A) Morphine 2 mg IV: Morphine is a potent opioid analgesic commonly used to manage moderate to severe pain. However, in this scenario, the client reports pain as 5 on a scale of 0 to 10, which indicates moderate pain. Morphine 2 mg IV may be excessive for this level of pain and could result in unnecessary sedation, respiratory depression, or other opioid-related adverse effects. Therefore, it is not the most appropriate choice for managing the client's pain.

B) Amitriptyline 25 mg PO: Amitriptyline is a tricyclic antidepressant with analgesic properties, but it is not typically used as a first-line treatment for acute postoperative pain. Additionally, it is administered orally and may not provide rapid pain relief in the immediate postoperative period. Therefore, it is not the most suitable option for managing the client's pain after a total knee replacement surgery.

C) Ketorolac 15 mg IV: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that provides potent analgesic and anti-inflammatory effects. It is commonly used for the management of moderate to severe pain, including postoperative pain. In this scenario, the client reports moderate pain after total knee replacement surgery, making ketorolac an appropriate choice for pain management. Administering ketorolac 15 mg IV can provide effective pain relief without the sedative effects of opioids, making it the most suitable PRN medication for the client's pain level.

D) Acetaminophen 650 mg PO: Acetaminophen is a non-opioid analgesic commonly used for mild to moderate pain relief. While acetaminophen is generally safe and effective, it may not provide sufficient pain relief for a client who reports pain as 5 on a scale of 0 to 10 after total knee replacement surgery. Additionally, oral administration may result in delayed onset of action compared to IV medications. Therefore, acetaminophen 650 mg PO may not be the most optimal choice for managing the client's pain in this situation.

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.