The physician orders 52 units of Humulin NPH insulin and 16 units of Humulin R insulin subcutaneously every morning.

The medication is supplied in 100 units/mL. How many units will the nurse administer? (Shade SYRINGE #3; LABEL CORRECTLY TO RECEIVE CREDIT)

Step 1 is to determine the total infusion time in minutes. 1 L = 1000 mL. 1000 mL ÷ (150 mL/h) = 6.666. hours. 6.666. hours × (60 min/hour) = 400 minutes.

Step 2 is to calculate the flow rate in drops per minute. (1000 mL ÷ 400 min) × (10 gtts/mL) = 25 gtts/min. The flow rate is 25 gtts/min.

Choice A rationale

Assessing the client's skin for breakdown is important in general patient care, especially for immobile patients, but it is not a priority assessment directly related to the immediate physiological effects of administering an opioid analgesic like morphine. Skin integrity issues are typically a long-term complication.

Choice B rationale

Morphine, an opioid agonist, binds to mu-opioid receptors in the central nervous system, including the brainstem respiratory centers. This binding causes dose-dependent respiratory depression by decreasing the sensitivity of these centers to carbon dioxide, leading to reduced respiratory rate and depth. Normal respiratory rate is 12-20 breaths/min.

Choice C rationale

Opioids can cause urinary retention by increasing bladder sphincter tone and reducing detrusor muscle contractility, thereby impairing bladder emptying. While monitoring urinary output is important, respiratory depression is a more immediate and life-threatening adverse effect of opioid administration. Normal urinary output is 30-50 mL/hour.

Choice D rationale

Opioids commonly cause gastrointestinal side effects, including decreased gut motility, leading to constipation and reduced bowel sounds. While assessing abdominal sounds is relevant to monitor for ileus, respiratory depression poses a more acute and significant risk to patient safety following opioid administration.