Which of these situations would cause the nurse to hold a dose of morphine?
The temperature is above 100.4 degrees Fahrenheit (38 degrees Celsius).
The blood pressure is above 140 mm Hg systolic.
Respiratory rate of 10 breaths per minute with an oxygen saturation level of 86%.
The heart rate is above 90 beats per minute.
The Correct Answer is C
A) Elevated temperature is not a typical reason to withhold morphine unless there are other concerns, such as infection.
B) Elevated blood pressure alone is not a reason to withhold morphine, but it should be considered in the context of the overall clinical picture.
C) A respiratory rate of 10 breaths per minute with low oxygen saturation indicates respiratory depression, which is a significant concern and a reason to withhold morphine.
D) An elevated heart rate alone is not a reason to withhold morphine, but it should be considered in the context of the overall clinical picture.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
a) Amlodipine is a calcium channel blocker and is less likely to cause angioedema compared to ACE inhibitors like captopril.
b) Budesonide is a corticosteroid and is not typically associated with angioedema.
c) Simvastatin is a statin and is not known to cause angioedema.
d) Captopril is an ACE inhibitor, and angioedema is a known adverse effect. In the presence of localized swelling of the lips and tongue, discontinuation of captopril is likely indicated.
Correct Answer is A
Explanation
a) An elevated temperature could indicate an infection, which is a serious concern in a client taking steroids, as steroids can suppress the immune system. This finding should be reported immediately.
b) Blood pressure within this range is generally acceptable and may not be a cause for immediate concern.
c) A glucose level of 128 mg/dl is within a reasonable range and may not require immediate reporting unless there are other concerning factors.
d) A heart rate of 102 beats per minute is generally within an acceptable range and may not be an immediate cause for concern in the absence of other symptoms.
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