A client who is allergic to morphine has been receiving meperidine (Demerol) 75–100 mg IM every 6 hours for the last 3 days. Five hours after the last dose, the client calls the nursing desk and says, "I need some pain medication
I am hurting so badly that I am shaking." What should the nurse do?
Standard Text: Select all that apply.
1. Administer the 100 mg dose.
2. Administer the 75 mg dose.
3. Administer 50 mg of meperidine.
4. Collaborate with the client's health care provider regarding the medication and schedule.
5. Ask the client when the shaking first began.
Correct Answer: 4,5
Rationale 1: The client's condition does not indicate need for 100 mg of the medication.
Rationale 2: The client's condition does not indicate need for 75 mg of the medication.
Rationale 3: There is no order for a 50 mg dose and the client's condition does not indicate the need for additional meperidine.
Rationale 4: Meperidine can become toxic at doses greater than 400–600 mg per day or if given over 48 hours. One of the symptoms of toxicity is tremors and seizures. The nurse should discuss the symptoms with the health care provider, who should change the medication.
Rationale 5: Before contacting the health care provider, the nurse should complete additional assessment regarding the shaking and the pain.
Global Rationale: Meperidine can become toxic at doses greater than 400–600 mg per day or if given over 48 hours. One of the symptoms of toxicity is tremors and seizures. The nurse should discuss the symptoms with the health care provider, who should change the medication. Before contacting the health care provider, the nurse should complete additional assessment regarding the shaking and the pain. The client's condition does not indicate need for 100 mg of the medication. The client's condition does not indicate need for 75 mg of the medication. There is no order for a 50 mg dose and the client's condition does not indicate the need for additional meperidine.
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