The nurse is caring for a client.

Which of the following 4 orders or prescriptions should the nurse anticipate?
Select the 4 orders or prescriptions that the nurse should anticipate.

Rationale for correct choices

• Heart sounds: The presence of S3 and S4 heart sounds may indicate right ventricular strain or acute heart failure, which can occur secondary to a massive pulmonary embolism. This finding aligns with increased cardiac workload due to impaired pulmonary circulation. Heart sounds are not typically altered in pneumonia or pneumothorax unless severe cardiac compromise occurs.

• Respiratory pattern: Tachypnea and labored breathing can occur in all three conditions. In pulmonary embolism, rapid breathing compensates for hypoxemia. In pneumonia, increased respiratory rate results from impaired gas exchange and inflammation. In pneumothorax, rapid breathing occurs due to decreased lung expansion and oxygenation.

• Temperature: Fever (38.9° C/102° F) suggests an infectious process, consistent with pneumonia. Pulmonary embolism and pneumothorax typically do not present with elevated temperature unless secondary infection or inflammatory response is present.

• Lung sounds: Bilateral crackles indicate fluid or exudate in the alveoli. In pneumonia, crackles result from consolidation and inflammation. In pulmonary embolism, crackles may reflect pulmonary infarction or edema from right-sided heart strain. Pneumothorax generally produces absent or decreased breath sounds rather than crackles, so crackles are less indicative.

A. Morphine 2 mg IV bolus every 4 hr PRN pain: The prescription clearly indicates the dose, route, frequency, and PRN instructions, making it complete and appropriate for administration.

B. Acetaminophen 1,000 PO three times daily: The prescription is missing the unit of measure (mg, g, etc.), which is essential to ensure safe dosing. Without the unit, there is a risk of overdose or underdose, so the nurse must verify this prescription with the provider before administration.

C. Ibuprofen 800 mg PO every 8 hr: This prescription includes the dose, route, and frequency, making it complete. While monitoring for side effects is important, there is no issue requiring verification.

D. Ceftriaxone 250 mg IM x1 dose now: The prescription specifies the dose, route, and single administration, making it clear and safe to administer without additional verification.