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.

Answer and Explanation

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.

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Correct Answer is C

Explanation

A) "I know it is really busy but I do not have time to help you either. I have my own clients.": While it may be tempting to express frustration due to being busy, this response lacks professionalism and does not address the situation appropriately. As healthcare professionals, it is important to communicate effectively and collaborate with colleagues to ensure safe patient care, even when busy. Instead, the nurse should express the need to follow protocols while offering help in a safe manner.

B) "Are you sure the doctor ordered that much morphine? It seems like a lot to give all at once.": Although questioning the dosage is part of safe nursing practice, this response is unnecessary in this situation. If there is a concern about the prescribed amount of morphine, it should be verified with the healthcare provider. However, this question does not directly address the issue of administering the medication safely. It also does not ensure that the nurse is following correct protocols for preparing and administering medication.

C) "I can give your client their pain medications, but I need to draw up and prepare it myself.": This response is the most appropriate because it ensures the nurse is adhering to safe medication administration practices. The nurse should always prepare and administer medications themselves to verify the correct dosage, route, and patient. Allowing another nurse to prepare medication and administering it without proper verification can lead to medication errors. This response also shows willingness to help while maintaining safety standards.

D) "Sure thing, give me that syringe and I will give it for you while you are on break.": This response is inappropriate because it involves accepting medication from another nurse without verifying that the correct drug, dose, and preparation have been followed. It is unsafe to administer medications prepared by others without reviewing the medication and ensuring that everything is accurate. Nurses must always prepare and administer their own medications to prevent potential medication errors.

A. True B. False

Correct Answer is A

Explanation

CYP 450 enzymes are responsible for the metabolism of many drugs. Smoking can induce certain CYP 450 enzymes, particularly CYP1A2, which leads to an increase in the metabolism of drugs that are substrates of this enzyme. When a person begins smoking, the induction of these enzymes can cause drugs to be metabolized more quickly, which typically results in lower drug levels in the body. However, the statement asks whether the level of medication will increase in this client, and since smoking induces enzyme activity, it would typically lead to decreased, not increased, drug levels. However, in the context of drug-drug interactions and other metabolic pathways, the metabolism rate could be altered in ways that might increase or affect the therapeutic response.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A client currently prescribed a medication highly metabolized by the CYP 450 recently began smoking due to a stressful life event. True or False: The level of medication will increase in this client.

Correct Answer is A

Explanation

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