A nurse is reviewing a provider's prescription that reads: "Administer morphine sulfate 2 mg IV q4h PRN for pain." Which interpretation of the abbreviations demonstrates correct understanding?

Administer 2 mg of morphine sulfate intravenously every 4 hours as needed for pain

Administer 2 mg of morphine sulfate by mouth every 4 hours as needed for pain

Administer 2 mg of morphine sulfate intravenously every 4 hours without regard to pain

Administer 2 mg of morphine sulfate intramuscularly every 4 hours as needed for pain

Answer and Explanation

The Correct Answer is A

A. Administer 2 mg of morphine sulfate intravenously every 4 hours as needed for pain: “IV” indicates intravenous administration. “q4h” means every 4 hours, and “PRN” signifies that the medication should be given only as needed based on the client’s reported pain. This interpretation correctly translates all components of the prescription.

B. Administer 2 mg of morphine sulfate by mouth every 4 hours as needed for pain: “By mouth” would be abbreviated as PO, not IV. The prescription specifically indicates intravenous administration, which allows for rapid onset and precise titration. Misinterpreting the route could significantly alter onset, bioavailability, and clinical effect.

C. Administer 2 mg of morphine sulfate intravenously every 4 hours without regard to pain: The abbreviation “PRN” means as needed, not scheduled regardless of symptoms. Administering morphine on a fixed schedule without assessing pain disregards the conditional nature of the order and may increase the risk of oversedation or respiratory depression.

D. Administer 2 mg of morphine sulfate intramuscularly every 4 hours as needed for pain: Intramuscular administration is abbreviated as IM, not IV. Changing the route from intravenous to intramuscular would alter absorption rate, onset of action, and patient comfort. Accurate interpretation of route abbreviations is critical for safe medication administration.

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Correct Answer is B

Explanation

A. Monitoring the client's blood pressure regularly: Blood pressure monitoring is important because MAOIs can precipitate hypertensive crises. However, prevention is more critical than detection after the fact. Relying solely on monitoring does not eliminate the underlying trigger for severe hypertension associated with dietary interactions.

B. Educating the client on the importance of avoiding foods high in tyramine: MAOIs inhibit monoamine oxidase, the enzyme responsible for breaking down tyramine in the gastrointestinal tract. Accumulation of tyramine leads to excessive norepinephrine release, causing severe vasoconstriction and potentially life-threatening hypertensive crisis. Avoiding aged cheeses, cured meats, fermented products, and certain alcoholic beverages is essential for safety.

C. Administering the medication with a full glass of milk: There is no pharmacologic requirement to administer MAOIs with milk. Food does not significantly alter the drug’s mechanism of action related to monoamine oxidase inhibition.

D. Assessing the client's fasting blood sugar levels before administration: MAOIs are primarily used for treatment-resistant depression and certain anxiety disorders. They do not directly alter glucose metabolism in a predictable manner that would require routine fasting glucose assessment prior to administration.

A. "I'll report any new confusion, dizziness, or unsteady gait that occurs after starting a new medication." B. “I’ll avoid abruptly stopping any medication, even if I start to feel better." C. "Because my metabolism has slowed down, it might take longer for medications to start working, so I can take another dose if I don't feel better." D. "Since my kidneys don't clear drugs as efficiently, I should avoid taking over-the-counter medications unless approved by my provider."

Correct Answer is C

Explanation

A. "I'll report any new confusion, dizziness, or unsteady gait that occurs after starting a new medication.": Older adults are more susceptible to central nervous system effects due to altered pharmacokinetics and increased blood-brain barrier permeability. Symptoms such as confusion, dizziness, or gait instability increase fall risk and may indicate drug accumulation or sensitivity.

B. “I’ll avoid abruptly stopping any medication, even if I start to feel better.": Abrupt discontinuation of certain medications, such as beta-blockers, benzodiazepines, or antidepressants, can result in rebound effects or withdrawal symptoms. Gradual tapering is often required to maintain physiologic stability.

C. "Because my metabolism has slowed down, it might take longer for medications to start working, so I can take another dose if I don't feel better.": Age-related reductions in hepatic metabolism and renal clearance increase the risk of drug accumulation and toxicity. Taking an extra dose without provider guidance can lead to supratherapeutic levels and adverse effects.

D. "Since my kidneys don't clear drugs as efficiently, I should avoid taking over-the-counter medications unless approved by my provider.": Renal function often declines with age, reducing drug clearance and increasing susceptibility to toxicity. Many over-the-counter medications, including NSAIDs and antihistamines, can impair renal function or interact with prescribed therapies.

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A nurse is reviewing a provider's prescription that reads: "Administer morphine sulfate 2 mg IV q4h PRN for pain." Which interpretation of the abbreviations demonstrates correct understanding?

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