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A nurse is caring for a client who is receiving morphine. Which of the following assessments should the nurse perform first?

A.

Mostly cloudy

B.

Apical heart rate

C.

Blood pressure

D.

Respiratory rate

E.

Level of consciousness

Answer and Explanation

The Correct Answer is D

Rationale: 

 

A. Mostly cloudy: This option appears to be incorrectly stated. It does not pertain to a critical client assessment related to morphine administration. 

 

B. Apical heart rate: Monitoring the heart rate is important, but respiratory depression is a more immediate and life-threatening concern with morphine administration, so it is not the first priority. 

 

C. Blood pressure: Morphine can cause hypotension, but this is not as critical as respiratory depression, which must be assessed first in opioid administration.

 

D. Respiratory rate: The most critical assessment when administering morphine is the respiratory rate, as opioid medications like morphine can cause respiratory depression, which can be life-threatening if not addressed. 

 

E. Level of consciousness: While important, changes in consciousness typically follow respiratory depression, so assessing the respiratory rate takes priority.

 


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View Related questions

Correct Answer is C

Explanation

Rationale:

A. Furosemide is a diuretic that promotes urine production but is not indicated for treating bladder distention or urinary retention post-surgery.

B. Lorazepam is an anxiolytic medication and does not address urinary retention or bladder distention.

C. Bethanechol is a cholinergic agent that stimulates bladder contraction and is used to treat urinary retention. It helps to facilitate voiding in clients who have difficulty.

D. Atropine is an anticholinergic medication that can actually inhibit bladder contraction, making it inappropriate for this situation.

Correct Answer is D

Explanation

Rationale:

A. This statement is incorrect because omeprazole is not an antibiotic and does not kill bacteria; it is a proton pump inhibitor (PPI) that reduces acid production.

B. This statement is incorrect; omeprazole does not neutralize stomach acid, but rather decreases its production.

C. This statement is also incorrect; omeprazole does not coat the stomach lining; it works by inhibiting the proton pumps in the stomach lining to reduce acid secretion.

D. This statement is correct; omeprazole reduces stomach acid production, which is beneficial for managing GERD symptoms.

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