At 2000, you phone Dr. A.'s partner, who is on call. She prescribes morphine sulfate 4 to 10 mg IV push (IVP) q1h prn for pain (burning, pressure, and angina)
Explain two reasons for this order.
What special precautions should you follow when administering morphine sulfate via IVP?
The pharmacy supplies morphine for injection in vials of 5 mg/mL only. For the first dose,
you will be giving 4 mg of morphine. How many milliliters will you give for this dose? Mark
the syringe with your answer.
What will you do with the rest of the morphine in the vial?
a. Discard it.
b. Save it for the next dose.
c. Return it to the pharmacy.
d. Discard it with a second witness.
• Morphine sulfate, an opioid analgesic, will decrease pain and help reduce his stress.
• Morphine sulfate functions to dilate pulmonary vessels and decrease preload on the heart.
• Morphine sulfate dilates the coronary arteries to increase blood flow and oxygen delivery and
promote tissue perfusion.
• Relieving pain will help decrease myocardial oxygen demand.
• Ask about prior allergy, hypersensitivity reaction to morphine sulfate, or impaired liver function.
• Assess VS, especially respirations (do not administer if respirations are less than 10 breaths/min);
level of consciousness with opioid use; and location and intensity of pain before and 30 to 60
minutes after administration.
• Administer IVP over 4 to 5 minutes (for 15 mg or less).
• Start with smallest dose ordered and titrate to eliminate pain.
0.8 mL
Answer: d
Morphine is a Schedule II drug, and any drug that is not used needs to be "wasted" with a second
witness documenting that the drug was discarded.
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A severely ill critical care patient is receiving intravenous opioids for pain management. The physician adds a nonsteroidal anti-inflammatory drug (NSAID) to the patient's plan of care
The nurse understands that the most significant advantage of adding this drug is what? A) NSAIDs are cheaper than opioids while providing the same pain relief. B) Inhibition of prostaglandin and histamine at the site of injury will relieve pain without sedation. C) NSAIDs are available without prescription. D) Addiction and physical dependence are less of a problem with NSAIDs.
A client reports morning headache that extends into the neck and goes away as the day wears on. Based on this initial data, which does the nurse suspect that the client is experiencing?
A) A symptom of hypertension B) A sinus headache C) A migraine headache D) Spinal stenosis
The intensive care nurse is assessing a group of clients. Which clients does the nurse identify as likely requiring intubation? Select all that apply.
A) A client with a closed head injury. B) A client with severe laryngeal edema. C) A client with projectile vomiting. D) A client with cervical stenosis. E) A client with multiple rib fractures.
The discharge instruction given by the nurse that would be informative to a tuberculosis patient who asks how to protect his family members from his disease is:
1. "Your family will need to take treatment to prevent infection." 2. "You will need to wear a mask at home to protect your family members." 3. "You should cover your mouth and nose if coughing or sneezing." 4. "You should avoid intimate contact with everyone."