The nurse is providing care for a client who is alert and has very limited ability to move
independently in bed. Which problem(s) associated with bone demineralization is a concern for the nurse? (Select all that apply)

A. Assess vital signs: Morphine is a potent opioid agonist that can cause life-threatening respiratory depression and hypotension. Establishing a baseline respiratory rate and blood pressure is the critical safety step before administration. This ensures the client can hemodynamically tolerate the CNS-depressant effects of the medication.

B. Assess bowel sounds: While opioids decrease gastrointestinal motility and can lead to paralytic ileus, this is a secondary concern compared to immediate respiratory safety. Assessing bowel sounds is part of a comprehensive post-operative exam but is not the priority action before analgesic administration.

C. Listen to breath sounds: Auscultating for adventitious sounds provides information about lung aeration, but the primary risk of morphine is a decrease in respiratory rate and depth. While important, it is less critical than the quantitative assessment of the respiratory rate and overall hemodynamic stability.

D. Determine the date of the client's last bowel movement: This information helps manage potential opioid-induced constipation, but it has no bearing on the immediate safety of administering an acute dose for severe pain. Pain management and respiratory monitoring take clinical precedence over bowel history in the early post-operative period.

A. Dizziness: This is a common and often transient side effect of buprenorphine, especially during the induction phase of treatment. While it requires monitoring for patient safety and fall prevention, it does not typically constitute an acute clinical emergency. It is an expected pharmacological reaction to the initiation of therapy.

B. Headache: Cephalalgia is one of the most frequently reported side effects of sublingual buprenorphine/naloxone. It is usually manageable with non-opioid analgesics and does not indicate a failure of the induction process. It does not require immediate notification of the provider unless it is severe or neurological.

C. Muscle cramps: The presence of muscle cramps, along with other symptoms like diaphoresis or tachycardia, suggests that the client is experiencing precipitated withdrawal. Buprenorphine has a high affinity for mu-receptors and can displace full opioid agonists. This indicates the induction timing or dosage may need immediate medical adjustment.

D. Blood pressure of 126/89: This blood pressure reading represents a stable hemodynamic state and is not indicative of acute distress or severe withdrawal. While the diastolic pressure is at the high end of normal, it does not warrant an emergency call. It does not reflect the systemic instability of precipitated withdrawal.