A nurse is preparing to administer NPH insulin and regular insulin in the same syringe for a client. Which of the following actions should the nurse take?

Postoperative pain management requires rapid onsetof action to maintain the client within a therapeutic comfort window. During the immediate post-anesthesiaperiod (the first 24 hours), the gastrointestinal tract may have decreased motility, making systemic absorption via the bloodstream the most reliable method. Effective analgesia is crucial for early mobilization and preventing complications like venous thromboembolism.

Rationale:

A.The intravenous route is the priority for a client who is only 6 hours postoperative because it provides immediate bioavailability and rapid peak effect. Following a major orthopedic surgery like a hip fixation, pain levels are typically high and require the fast-acting relief that IV opioids or non-opioids provide. This route allows for precise titration of the medication based on the client’s immediate pain response.

B.The oral route is generally avoided in the very early postoperative period due to the risk of postoperative ileus and nausea related to anesthesia. Oral medications have a slower onset of action, typically taking 30 to 60 minutes to reach peak effect, which is insufficient for acute, severe surgical pain. This route is more appropriate once the client is stable and bowel sounds have returned.

C.Sublingual administration is useful for certain medications but is not the standard of care for acute postoperative pain following major surgery. Most potent surgical analgesics are not formulated for sublingual use. The nurse requires a route that can deliver a wide range of analgesic agents reliably, making the intravenous route superior for the immediate recovery phase of a hip surgery.

D.The intramuscular route is generally discouraged for postoperative pain because it is painful, results in inconsistent absorption, and has a slower onset than the intravenous route. Repeated IM injections can cause tissue damage and hematomas, especially in surgical clients who may be on anticoagulants. Modern nursing practice favors IV access for acute pain to ensure consistent and rapid relief.

Amlodipine is a long-acting dihydropyridine calcium channel blockerthat inhibits the transmembrane influx of calcium ions into vascular smooth muscle. It primarily causes systemic vasodilation, effectively reducing peripheral vascular resistance and lowering arterial blood pressure in hypertensive patients.

Rationale:

A.Oxygen saturation is a measure of hemoglobin oxygen binding and is not directly affected by the administration of calcium channel blockers like amlodipine. While respiratory assessment is part of general nursing care, it is not the priority parameter for a medication that targets vascular resistance. Amlodipine does not interfere with pulmonary gas exchange or the oxygen-carrying capacity of the blood.

B.Heart rate is a critical assessment for non-dihydropyridines like diltiazem, but amlodipine has minimal effect on the sinoatrial or atrioventricular nodes. Because amlodipine is vascular-selective, it does not typically cause the bradycardia associated with other calcium channel blockers. While reflexive tachycardia can occur due to vasodilation, blood pressure remains the most vital parameter to assess prior to dosing this specific agent.

C.Blood pressure must be assessed before administering amlodipine because its primary pharmacological effect is to lower systemic blood pressure through vasodilation. Giving the medication to a patient who is already hypotensive could lead to severe cardiovascular compromise, dizziness, or syncope. The nurse must ensure the client's pressure is within the safe parameters established by the provider to prevent iatrogenic hypotension.

D.Respiratory rate is not influenced by amlodipine, as the drug does not act on the central nervous system respiratory centers or the musculature of the diaphragm. Unlike opioids or certain sedatives, amlodipine does not carry a risk of respiratory depression. Monitoring the breathing rate, while standard, does not provide information relevant to the safety or hemodynamic impact of this antihypertensive medication.