The nurse mixes diphenhydramine 25 mg in a 100 mL bag of 0.9% sodium chloride, which is to be administered IV over 30 minutes. The IV pump should be set to administer how many mL/hour? (Enter numeric value only.)

A. Nausea: Morphine commonly causes nausea, which can lead to dizziness and unsteadiness when standing or moving. This increases the client’s risk of falls, especially when transitioning from bed to chair or ambulating postoperatively.

B. Euphoria: While morphine may cause a sensation of euphoria, this emotional effect alone does not directly contribute to physical instability or fall risk in the immediate postoperative period.

C. Itching: Itching is a common side effect of opioids but does not impair balance or mobility directly, so it is not a significant contributor to fall risk.

D. Orthostatic hypotension: Morphine can cause vasodilation, leading to drops in blood pressure when moving from lying to sitting or standing. Orthostatic hypotension can result in lightheadedness or fainting, sharply increasing the risk of falls.

E. Seizures: Seizures are rare side effects of morphine, typically associated with very high doses or toxicity. They are not in standard therapeutic use to be considered a primary fall risk factor.

F. Urinary retention: Urinary retention is a side effect of morphine but does not directly cause instability or contribute to falls unless it leads to urgency and hurried movement, which is less typical.

G. Sedation: Sedation is one of the most significant opioid side effects contributing to falls. Reduced alertness and slower reflexes make it much harder for clients to safely ambulate or protect themselves from falls.

Understanding:

• "If this treatment plan does not work, there are other drugs and combinations of drugs that I can get from my doctor to manage my asthma."
• "Even with asthma, I can maintain normal activity levels."
• "I should keep track of my peak expiratory flow to see how well I am managing my asthma."
• "I can decrease my risk of asthma attacks if I reduce my exposure to allergens in my home."

No Understanding:

• "The inhaled fluticasone that I was prescribed carries just as much risk as an oral steroid."
• "I should discontinue using albuterol after I fill my prescription for fluticasone."

Rationale:

• "The inhaled fluticasone that I was prescribed carries just as much risk as an oral steroid." This shows no understanding because inhaled corticosteroids like fluticasone have much lower systemic absorption compared to oral steroids, minimizing systemic side effects while still controlling airway inflammation locally.
• "If this treatment plan does not work, there are other drugs and combinations of drugs that I can get from my doctor to manage my asthma." This shows understanding because asthma management follows a stepwise approach. Treatment is escalated if control is not achieved, using combinations like LABAs, leukotriene modifiers, or biologics.
• "Even with asthma, I can maintain normal activity levels." This shows understanding because the goal of asthma management is to control symptoms so that clients can perform normal daily activities without limitation, including exercise and work.
• "I should keep track of my peak expiratory flow to see how well I am managing my asthma." This shows understanding because peak flow monitoring helps detect early decreases in lung function, guiding self-management decisions and the need for treatment adjustments.
• "I can decrease my risk of asthma attacks if I reduce my exposure to allergens in my home." This shows understanding because environmental control measures, such as reducing dust mites, pet dander, and mold, are key strategies to lower asthma exacerbation risk and improve long-term control.
• "I should discontinue using albuterol after I fill my prescription for fluticasone." This shows no understanding because albuterol, a rescue inhaler, should still be kept available for acute symptom relief even when a daily controller medication like fluticasone is added.