A postoperative patient has an IV saline lock in place. During assessment, the patient reports pain at 6 on a 0-10 scale. The nurse notes the following order for the patient
Physician Order: Morphine Sulfate 6-8mg every 4 hours PRN for pain.
Given the order and the patient's condition, which action should the nurse take?
Administer 8 mg IV
Administer 6 mg IV
Administer 7mg IV
Contact the Physician
The Correct Answer is B
A. Administer 8 mg IV: Giving the highest dose may not be appropriate initially. Since the patient is reporting moderate pain (6/10), the nurse should start with the lowest effective dose within the prescribed range before escalating.
B. Administer 6 mg IV: This is the safest action. Starting with the lowest ordered dose provides pain relief while minimizing the risk of adverse effects such as respiratory depression. The nurse can reassess pain and administer more later if needed.
C. Administer 7 mg IV: While mathematically between 6 and 8, the most clinically prudent and common practice is to use the low or high end of the ordered range, reserving the low dose for initial treatment.
D. Contact the Physician: There is no need to contact the physician because the order is clear, and the nurse can proceed with the lowest dose in the range to manage the patient’s pain safely.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Ordered medication: Tramadol (an opioid agonist, brand name Ultram). Available medication: Toradol (a non-steroidal anti-inflammatory drug or NSAID, generic name ketorolac). The two medications are different drugs with different actions, classifications, and patient indications. Tramadol is not the same drug as Toradol.Administering Toradol when Tramadol is ordered constitutes a medication error.
Correct Answer is A
Explanation
A. increased risk for speed shock: IV push medications enter the bloodstream rapidly, creating a high risk for speed shock, which is a toxic reaction caused by sudden drug administration. Symptoms may include dizziness, hypotension, irregular pulse, and cardiovascular collapse if not controlled.
B. increased risk for infiltration: Infiltration occurs when IV fluid or medication leaks into surrounding tissue. While possible with any IV therapy, it is not uniquely associated with IV push administration, since the risk is higher with prolonged infusions.
C. increased risk for infection: Infection risk is present with all IV routes due to potential contamination, but IV push does not specifically increase this risk compared to other IV methods when proper aseptic technique is followed.
D. a slow drug response: IV push produces one of the fastest drug responses because the medication is delivered directly into circulation. This makes it the opposite of a slow response, which is more characteristic of oral routes.
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