The healthcare provider has ordered 5 mg morphine intravenously for pain control. At home, the client takes 30mg of morphine sulfate by mouth twice daily. The client asks the nurse why they are receiving such a small dose. What is the best response by the nurse?
Opioid drugs are highly addictive, and the healthcare provider concerned you will become addicted.
Morphine highly bound to protein in your blood and you are at risk for toxicity due to surgery.
"Morphine taken by mouth pass through the liver and some of the medication is made inactive."
The healthcare provider is cautious with opioids and starts low adjusts the dose up as needed.
The Correct Answer is C
A) Opioid drugs are highly addictive, and the healthcare provider is concerned you will become addicted: While it is true that opioids have the potential for addiction, this response does not address the actual reason for the difference in morphine dosages. The provider's decision is likely based on the pharmacokinetics of the drug rather than a concern about addiction. This response could create unnecessary concern for the client and does not explain the dose discrepancy.
B) Morphine is highly bound to protein in your blood, and you are at risk for toxicity due to surgery: While morphine is protein-bound, the primary reason for the difference in the intravenous (IV) dose is not related to protein binding. The main difference is related to the route of administration and how the body processes the drug. The nurse should provide a more accurate explanation regarding the absorption and metabolism of morphine rather than focusing on protein binding or potential toxicity.
C) "Morphine taken by mouth passes through the liver, and some of the medication is made inactive": This is the best response. When morphine is taken orally, it is absorbed into the bloodstream and passes through the liver before reaching systemic circulation, a process known as the "first-pass effect." During this process, a portion of the drug is metabolized and rendered inactive, meaning that a higher oral dose is required to achieve the desired effect. When morphine is administered intravenously, it bypasses the liver and directly enters the bloodstream, leading to a more immediate and potent effect, which is why a lower dose is needed.
D) "The healthcare provider is cautious with opioids and starts low and adjusts the dose up as needed": While this is a valid approach to opioid prescribing, it doesn't fully explain why the client is receiving a smaller dose intravenously. The reason for the dose difference is based on the route of administration and the pharmacokinetic properties of the drug, not just a general cautious approach. This answer doesn't provide a clear explanation of why the IV dose is smaller.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) 90 degrees: For intramuscular (IM) injections, including in the ventrogluteal site, the needle should be inserted at a 90-degree angle to ensure that the medication is deposited deep into the muscle tissue. This angle allows the needle to penetrate the skin and subcutaneous tissue directly into the muscle where it can be absorbed efficiently. The ventrogluteal site, being a large and well-muscled area, is ideal for IM injections because it is less likely to cause damage to nerves or blood vessels, and a 90-degree angle ensures proper placement of the medication.
B) 45 degrees: A 45-degree angle is commonly used for subcutaneous injections which go into the fatty tissue just beneath the skin. This angle ensures that the medication is delivered into the correct layer of tissue, allowing for slow absorption. However, when administering an IM injection, a 45-degree angle would not be deep enough to reach the muscle and could result in improper placement, potentially affecting the medication's effectiveness and increasing the risk of irritation at the injection site.
C) 15 degrees: A 15-degree angle is far too shallow for an intramuscular injection and is typically used for intradermal injections, where the medication is injected just beneath the skin into the dermal layer. Using such a shallow angle for an IM injection would likely cause the needle to remain in the subcutaneous tissue, preventing the medication from reaching the muscle layer and significantly reducing its effectiveness.
D) 60 degrees: A 60-degree angle is too steep for intramuscular injections. At this angle, the needle may not effectively reach the muscle tissue and could cause the medication to be injected too superficially into the subcutaneous layer. This would not allow for proper absorption of the drug and may lead to irritation or a delayed therapeutic effect.
Correct Answer is B
Explanation
Here's the process for calculating the drug concentration after multiple half-lives:
First half-life: After 1 half-life, 50% of the original dose remains in the body.
200 mg x 0.50 = 100 mg remains after 1 half-life.
Second half-life: After 2 half-lives, 50% of the remaining drug will be eliminated.
100 mg x 0.50 = 50 mg remains after 2 half-lives.
Third half-life: After 3 half-lives, 50% of the remaining drug will be eliminated again.
50 mg x 0.50 = 25 mg remains after 3 half-lives.
Fourth half-life: After 4 half-lives, 50% of the remaining drug will be eliminated once more.
25 mg x 0.50 = 12.5 mg remains after 4 half-lives.
Now, we need to sum up the amount of drug remaining in the body at each half-life:
After 4 half-lives, there are 12.5 mg left from the original dose.
Total drug in the body after 4 half-lives = 200 mg - 12.5 mg = 375 mg.
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