A nurse is assigned to care for a client who has been prescribed an opioid analgesic. Which of the following activities should the nurse perform as part of the preadministration assessment?

Question

A) Document description of pain and an estimate of when the pain began.
B) Obtain client's blood pressure and pulse within 5 to 10 minutes.
C) Monitor the client for symptoms of respiratory depression.
D) Record each bowel movement and its appearance, color, and consistency.

Answer 1

Ans: A
Feedback:
The nurse should document the description of pain and an estimate of when the pain began as part of the preadministration assessment. Obtaining blood pressure and pulse within 5 to 10 minutes, monitoring the client for symptoms of respiratory depression, and recording bowel movements are part of the ongoing assessments conducted by the nurse when caring for the client. The nurse obtains the blood pressure, pulse and respiratory rate, and pain rating in 5 to 10 minutes if the drug is given intravenously (IV). Respiratory depression occurs in clients who do not use opioids routinely and are being given an opioid drug for acute pain relief or surgical procedures. When an opiate is used as an antidiarrheal drug, the nurse records each bowel movement, as well as its appearance, color, and consistency.