A nurse is providing discharge teaching about car seat safety to a parent of a newborn. Which of the following statements by the parent indicates an understanding of the teaching?

Rationale:
A. Morphine typically causes miosis (constricted pupils), not dilation. A pupil diameter of 6 mm (dilated pupils) is not an expected therapeutic effect, but it is not the most immediately life-threatening finding in this scenario compared with severe hypotension.

B. This equates to about 30 mL/hr, which is borderline low but still may be acceptable depending on the client’s weight, hydration status, and clinical context. Morphine can also cause urinary retention, so this finding should be monitored but is not the priority.

C. Constipation is a very common adverse effect of morphine due to decreased gastrointestinal motility. While important to address with stool softeners or laxatives, it is not an acute emergency.

D. This is the priority finding because it indicates severe hypotension, which can lead to decreased tissue perfusion, shock, and organ failure. Morphine can cause vasodilation and histamine release, contributing to hypotension, especially when given IV. This requires immediate intervention and provider notification first, as it is life-threatening.

Rationale:

A. The client’s heart rate is 98/min, which is within the upper normal range. It may reflect mild anxiety, medication effects, or mild dehydration, but it is not critically abnormal and does not require immediate provider notification.

B. The client is taking clozapine, an atypical antipsychotic associated with a serious adverse effect: agranulocytosis (severe neutropenia). A sore throat can be an early sign of infection due to a dangerously low white blood cell count. This symptom must be reported immediately so that a CBC with differential can be obtained and the medication potentially held to prevent life-threatening infection.

C. The blood pressure is 102/56 mm Hg, which is mildly low but can be expected in clients taking antipsychotic medications like clozapine due to orthostatic hypotension. The client reports dizziness on position change, which is consistent with this known side effect and is managed with safety teaching and monitoring rather than urgent provider notification.

D. The client ate 75% of breakfast, which indicates adequate oral intake. Mild nausea and dry mouth are common side effects of clozapine and do not, in isolation, require provider notification unless they significantly worsen or lead to poor intake or dehydration.