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

Here’s the step-by-step process:

After the first half-life (1 half-life), 50% of the initial drug is left.

200 mg → 100 mg (half is eliminated, 100 mg remains).

After the second half-life (2 half-lives), 50% of the remaining drug is eliminated again.

100 mg → 50 mg (half of 100 mg is eliminated, 50 mg remains).

After the third half-life (3 half-lives), 50% of the remaining drug is eliminated again.

50 mg → 25 mg (half of 50 mg is eliminated, 25 mg remains).

A. The mother should not take any medication while breast feeding in order to prevent harm to the infant B. Many medications cross into the breast milk in small amounts and could cause harm to the infant C. While medication can cross into the breast milk, no infants have ever been harmed because of this D. It is unlikely that a large enough amount of medication will cross into the breast milk and cause harm to the infant.

Correct Answer is B

Explanation

A) The mother should not take any medication while breast feeding in order to prevent harm to the infant: This statement is too restrictive and not accurate. While some medications should be avoided during breastfeeding, many medications can be taken safely in small amounts. The focus should be on which medications are safe for breastfeeding, not a blanket prohibition on all medications. Some medications are compatible with breastfeeding, and the benefits of taking them may outweigh any potential risks.

B) Many medications cross into the breast milk in small amounts and could cause harm to the infant: This statement is correct. While many medications do pass into breast milk in small amounts, it’s important to recognize that some medications can pose risks to the infant depending on the type of medication, dosage, and timing of breastfeeding. Nurses should educate the mother to always consult with a healthcare provider before taking any medication while breastfeeding.

C) While medication can cross into the breast milk, no infants have ever been harmed because of this: This statement is not accurate. While many medications may pass into breast milk in small amounts, there are documented cases of infants being harmed by medications transferred via breastfeeding. It is crucial to be cautious and informed about the safety of medications taken during breastfeeding.

D) It is unlikely that a large enough amount of medication will cross into the breast milk and cause harm to the infant: While it may be true that in many cases, only small amounts of medication pass into breast milk, this statement oversimplifies the issue. The amount and type of medication, as well as the infant’s age, weight, and health, are all factors that need to be considered. Some medications may pose a significant risk to the infant, and careful evaluation is necessary.

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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?

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Correct Answer is C

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The nurse is providing discharge instructions to a female client who delivered a healthy, full-term infant. What information should the nurse provide about taking medications while breast feeding?

Correct Answer is B

Explanation

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