The nurse observes myoclonic movements in an older client receiving IV morphine sulfate for pain. What should the nurse do with this finding?
1. Contact the prescribing health care provider.
2. Continue to monitor the client for side effects.
3. Obtain a prescription for a decreased dose.
4. Request to change from IV dosing to oral dosing.
1. Contact the prescribing health care provider.
Explanation: 1. Myoclonic jerking movements may be associated with high-dose opioid therapy especially morphine. An alternate opioid should be used if this occurs, and the physician needs to be contacted to change the medication order.
2. The nurse needs to do more than observe the client for more movements. This medication needs to be discontinued.
3. The morphine has built up a toxicity in the client and has to be discontinued, not reduced.
4. The morphine has built up a toxicity and this does not change in response to different forms of administration. Its use has to be discontinued.
You might also like to view...
The nurse is caring for a client who is experiencing chronic fatigue related to medication being taken for seasonal allergies. What should the nurse anticipate being prescribed to help this client?
A) A medication change to treat seasonal allergies B) Physical therapy to promote exercise C) Strategies to keep the client awake during the day D) Sleep medication to increase rest time
A client is admitted with a gunshot wound to the leg. Which of the following nursing diagnoses would be important to include in this client's plan of care?
1. Anxiety 2. Ineffective Coping 3. Risk for Infection 4. Situational Low Self-Esteem
Vomiting-induced metabolic alkalosis, resulting in the loss of chloride, causes:
a. Retained sodium to bind with the chloride b. Hydrogen to move into the cell and exchange with potassium to maintain cation balance c. Retention of bicarbonate to maintain the anion balance d. Hypoventilation to compensate for the metabolic alkalosis
The nurse recommends to parents that peanuts are not a good snack food for toddlers. The nurse's rationale for this action is that:
a. They are low in nutritive value. c. They cannot be entirely digested. b. They are very high in sodium. d. They can be easily aspirated.