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Exhibits

The charge nurse places a fall precautions sign on the client's door.

Which side effects of morphine could contribute to this client's fall risk? Select all that apply

Orthostatic hypotension

Sedation

Seizures

itching

Nausea

Urinary retention

Euphoria

Answer and Explanation

Correct Answer : A,B,E,F

A. Orthostatic hypotension: Morphine can cause vasodilation and reduce blood pressure, especially when the client moves from lying to standing positions. This drop in blood pressure increases the risk of dizziness and falls, particularly in postoperative patients who may already be weakened.

B. Sedation: Morphine’s central nervous system depressant effects can cause sedation and impaired alertness. Reduced cognitive and motor function from sedation significantly raises the client’s risk of falls by affecting balance and reaction time.

C. Seizures: Seizures are not a common side effect of morphine. While morphine affects the central nervous system, it typically does not provoke seizure activity in most clients, so it is less relevant as a direct fall risk factor.

D. Itching: Morphine commonly causes itching due to histamine release but this side effect does not directly increase fall risk. Itching may cause discomfort but is unlikely to impair balance or cognition.

E. Nausea: Morphine-induced nausea can cause dizziness, weakness, and dehydration, which contribute indirectly to fall risk. Nausea may also reduce food and fluid intake, worsening the client’s overall stability.

F. Urinary retention: Urinary retention can lead to urgency and frequent bathroom trips, increasing the likelihood of falls, especially if the client rushes or moves unassisted. Postoperative patients with retention are at higher risk of falls during toileting.

G. Euphoria: Euphoria is a central nervous system effect of morphine but does not typically impair balance or motor control to a degree that increases fall risk. It may affect mood but is not directly linked to falls.

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Free Nursing Study Resources

Correct Answer is D

Explanation

A. Use the cream only on intact skin: Topical corticosteroids like betamethasone should not be applied to open wounds or infected areas, as this can delay healing and worsen infection risk. Using it only on intact skin is an appropriate precaution.

B. Apply the cream to the area for 2 weeks: Betamethasone is typically prescribed for short-term use, often 1–2 weeks, to minimize the risk of skin thinning and systemic absorption. This duration aligns with safe therapy guidelines.

C. Limit exposure to direct sunlight: Corticosteroid use can make the skin more sensitive to sunlight and increase the risk of irritation. Limiting sun exposure is an appropriate preventive measure.

D. Cover the site with an occlusive dressing: Occlusive dressings significantly increase absorption of topical corticosteroids, raising the risk of local and systemic side effects. This method should only be used if specifically ordered by the healthcare provider.

A. Administer levothyroxine at bed time. B. Take medication on an empty stomach. C. Avoid the use of iron supplements. D. Consume foods that are high in iodine.

Correct Answer is B

Explanation

A. Administer levothyroxine at bed time: Levothyroxine is best taken in the morning to mimic the body’s natural hormone rhythm and to avoid interference from food, so taking it at bedtime is not standard unless specifically directed by the provider.

B. Take medication on an empty stomach: Levothyroxine absorption is optimal when taken on an empty stomach, ideally 30–60 minutes before breakfast, to avoid binding with food or other medications.

C. Avoid the use of iron supplements: Iron can interfere with levothyroxine absorption, but it can be taken if spaced at least 4 hours apart. Avoidance is not required, only timing adjustments.

D. Consume foods that are high in iodine: Excess iodine can actually disrupt thyroid function and is not recommended unless prescribed for a specific deficiency.

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Exhibits The charge nurse places a fall precautions sign on the client's door. Which side effects of morphine could contribute to this client's fall risk? Select all that apply

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Explanation

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Explanation

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Exhibits The charge nurse places a fall precautions sign on the client's door. Which side effects of morphine could contribute to this client's fall risk? Select all that apply

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Exhibits

The charge nurse places a fall precautions sign on the client's door.

Which side effects of morphine could contribute to this client's fall risk? Select all that apply