A patient is scheduled for surgery this morning and the nurse is administering the morning medications.

Which scheduled morning medication should the nurse withhold and not administer on the morning of surgery?

Choice A rationale
A client with a hip fracture and is on bedrest for 4 weeks may indeed experience constipation due to decreased physical activity. However, this situation would not necessarily require the nurse to question the order for psyllium. Psyllium is a bulk-forming laxative that can help relieve constipation by increasing stool bulk and improving bowel regularity.
Choice B rationale
Morphine is an opioid medication that can cause constipation as a side effect. Therefore, a client who is experiencing severe pain and is prescribed morphine may benefit from a laxative like psyllium to help manage opioid-induced constipation. This situation would not necessarily require the nurse to question the order for psyllium.
Choice C rationale
A client who is post-operative and is on a clear liquid diet may experience constipation due to the low fiber content of the diet. However, this situation would not necessarily require the nurse to question the order for psyllium. Once the client progresses to a regular diet, psyllium can help add bulk to the stool and promote regular bowel movements.
Choice D rationale
This choice is correct. A client with a recent stroke who has difficulty swallowing may be at risk for aspiration, or the inhalation of food or liquid into the lungs, when taking psyllium. Psyllium is a bulk-forming laxative that absorbs water in the intestines to form a softer, bulkier stool. If a client with swallowing difficulties were to aspirate the psyllium, it could potentially expand in the lungs when it comes into contact with moisture, leading to serious complications. Therefore, the nurse should question the order for psyllium in this situation.

Choice A rationale
While measuring the correct dosage is an important step in administering nystatin, it is not the first step. The first step should always be to ensure that the medication is properly mixed to ensure an even distribution of the medication.
Choice B rationale
Recording the amount of medication administered is an important step in medication administration, but it is not the first step. The first step should be to ensure that the medication is properly mixed.
Choice C rationale
Instructing the client to swish the nystatin around their mouth is an important part of the administration process, but it is not the first step. The first step should be to ensure that the medication is properly mixed.
Choice D rationale
Vigorously shaking the nystatin bottle is the first step in administering nystatin. This ensures that the medication is properly mixed and that the patient will receive the correct dosage.