A nurse is reviewing the medication administration record for a client who has cancer and is receiving morphine via a PCA pump. Which of the following prescriptions should the nurse clarify with the provider?

A) Instruct the ’lient that their central line dressing must be changed every 24 hr: While it's essential to maintain proper hygiene a’d care for a central line to prevent infection, changing the dressing every 24 hours may not be necessary. The frequency of dressing changes depends on institutional policies and the client's condition. Providing accurate informat’on about dressing changes based on specific guidelines is important for the client's safety and the prevention of central l’ne-related infections.

B) Instruct the client to weigh themselves daily and record their weight: This is the correct instruction. Monitoring daily weight allows for the assessment of fluid status and the effectiveness of TPN therapy. Weight gain or loss can indicate fluid retention or depletion, respectively, which may necessitate adjustments to the TPN prescription. Recording daily weights provides valuable data for healthcare providers to evaluate the client's response to TPN and make appropriate m’difications to the treatment plan.

C) Instruct the client that one container of TPN may infuse for up to 72 hr: The duration of TPN administration varies depending on factors such as the client's nutritional needs, medical condition, ’nd the stability of the TPN solution. While some TPN solutions may be stable for up to 24-48 hours, infusing for 72 hours could increase the risk of contamination and compromise the integrity of the solution, leading to adverse effects. Providing accurate information about the duration of TPN infusion based on the specific prescription ensures the client's safety and the efficacy of therapy.

D’ Instruct the client to speed up the rate of their TPN infusion if it falls behind schedule: Altering the rate of TPN infusion without healthcare provider guidance can lead to complications such as hyperglycemia, electrolyte imbalances, or fluid overload. TPN infusion rates are carefully prescribed based on the client's nutritional needs and metabolic status’ If the infusion falls behind schedule, it's essential for the client to contact th’ir healthcare provider for guidance on adjusting the infusion rate or managing any potential issues.

A) Increase in bowel function: Propofol is a sedative-hypnotic agent commonly used for induction and maintenance of anesthesia and sedation for procedures such as colonoscopies. While propofol may affect gastrointestinal motility, it typically leads to a decrease rather than an increase in bowel function. Therefore, an increase in bowel function would not be an expected adverse effect of propofol administration.

B) Increase in heart rate: Propofol generally has a depressant effect on the cardiovascular system, leading to a decrease rather than an increase in heart rate. It causes vasodilation and can result in hypotension and bradycardia, especially during induction of anesthesia. Therefore, an increase in heart rate would not be an expected adverse effect of propofol administration.

C) Decrease in respiratory rate: Respiratory depression is a well-known adverse effect of propofol. It acts as a potent central nervous system depressant, leading to dose-dependent respiratory depression. This effect is more pronounced when propofol is used for deeper levels of sedation or anesthesia. Therefore, monitoring for a decrease in respiratory rate is essential during and after propofol administration to prevent hypoxemia and respiratory compromise.

D) Decrease in body temperature: Propofol infusion syndrome (PRIS) is a rare but potentially fatal complication associated with prolonged high-dose propofol administration. Among its manifestations are metabolic acidosis, rhabdomyolysis, hyperlipidemia, and ultimately, multi-organ failure. However, a decrease in body temperature is not a characteristic feature of PRIS. Instead, hyperthermia or an increase in body temperature may occur as part of the syndrome. Therefore, monitoring for a decrease in body temperature is not a typical adverse effect of propofol administration.