A patient with congestive heart failure and pulmonary edema is experiencing chest pain.
The patient has been prescribed morphine sulfate IV 4 mg every 5-30 minutes as needed until chest pain subsides.
The last dose of 4 mg was administered 15 minutes ago, and the patient is still complaining of chest pain and showing signs of increased respiratory effort.
The nurse observes a heart rate of 82 beats per minute, a respiratory rate of 18 breaths per minute, and a blood pressure of 135/88 mm Hg. What should the nurse do next?

Request an order for morphine sulfate IV 2 mg over 1-5 minutes.

Withhold the next dose and inform the provider about the patient’s symptoms.

Administer naloxone (Narcan) to counteract respiratory depression.

Administer morphine sulfate IV 4 mg over 1-5 minutes.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Requesting an order for morphine sulfate IV 2 mg over 1-5 minutes would not be appropriate at this time for several reasons: The patient has already received a dose of 4 mg 15 minutes ago, and it has not been effective in relieving the chest pain.

The patient is showing signs of increased respiratory effort, which could be a sign of respiratory depression. Administering an additional dose of morphine could worsen the respiratory depression.

The patient's heart rate is 82 beats per minute, which is within the normal range.

The patient's blood pressure is 135/88 mm Hg, which is also within the normal range.

Choice C rationale:

Administering naloxone (Narcan) to counteract respiratory depression would not be appropriate at this time because the patient is not showing signs of severe respiratory depression. Naloxone is a medication that is used to reverse the effects of opioid overdose. It is typically only used in situations where the patient is experiencing life-threatening respiratory depression.

Choice D rationale:

Administering morphine sulfate IV 4 mg over 1-5 minutes would not be appropriate for the reasons listed above. It could worsen the patient's respiratory depression and potentially lead to other complications.

Choice B is the best answer because it is the most conservative and safest option. By withholding the next dose of morphine and informing the provider about the patient's symptoms, the nurse can ensure that the patient receives the appropriate care and that any potential complications are avoided.

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Correct Answer is B

Explanation

Choice A rationale:

Insulin lispro is a rapid-acting insulin that begins to work within 15 minutes of injection. If administered 15 minutes after eating, it may not be able to effectively control the rise in blood glucose levels that occurs after a meal. This could lead to hyperglycemia, which can have negative short-term and long-term health consequences.

Administering insulin lispro 15 minutes after eating would delay its action and potentially lead to suboptimal blood glucose control. It's crucial to match the timing of insulin administration with the meal to ensure optimal glucose management.

Choice C rationale:

Administering insulin lispro 10 minutes after eating would also delay its action. While not as delayed as 15 minutes, it still wouldn't align with the peak of meal-related glucose absorption, potentially leading to suboptimal glucose control.

Choice D rationale:

Insulin lispro has a shorter duration of action compared to regular insulin. Administering it 30 minutes before eating could lead to hypoglycemia, a condition characterized by low blood glucose levels. Hypoglycemia can cause a variety of symptoms, including shakiness, sweating, dizziness, confusion, and even loss of consciousness.

It's essential to closely align the timing of rapid-acting insulins like insulin lispro with mealtimes to minimize the risk of hypoglycemia.

A. Between 2100 and 0500 B. There is no peak action with neutral protamine hagedorn insulin C. Between 1800 and 2100 D. At 1930

Correct Answer is A

Explanation

Choice A rationale:
NPH insulin is an intermediate-acting insulin that typically peaks 6-12 hours after administration.
Given that the insulin was administered at 1700 (5:00 PM), the peak action would be expected to occur between 2100 (9:00 PM) and 0500 (5:00 AM).
This time frame aligns with the known pharmacokinetics of NPH insulin.
It's crucial for nurses to be aware of the peak action times of different insulin types to effectively manage blood glucose levels and adjust insulin doses accordingly.
Choice B rationale:
Incorrect. NPH insulin does have a peak action, as explained above.
It's important to understand that even intermediate-acting insulins have a period of peak activity when they exert their strongest glucose-lowering effect.
Choice C rationale:

Incorrect. This time frame is too early to represent the peak action of NPH insulin. The peak action typically occurs later, between 6-12 hours after administration.
Choice D rationale:
Incorrect. This time point is too specific to accurately represent the peak action of NPH insulin.
The peak action can vary within the 6-12 hour window, depending on individual factors and injection site.

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Naxlex Comprehensive Predictor Exams

A client is ordered to receive insulin lispro (Humalog) at mealtimes. When should the nurse instruct the client to administer the medication?

Correct Answer is B

Explanation

The nurse has administered NPH insulin at 1700. At what time would the nurse anticipate the peak action of this insulin?

Correct Answer is A

Explanation

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