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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. Sargramostim is a granulocyte-macrophage colony-stimulating factor (GM-CSF) used to stimulate the production of white blood cells but is not specifically indicated for anemia.

B. Filgrastim is a granulocyte colony-stimulating factor (G-CSF) that increases white blood cell counts and is not used for treating anemia.

C. Epoetin is an erythropoiesis-stimulating agent that stimulates red blood cell production, making it the appropriate choice for treating chemotherapy-induced anemia.

D. Romiplostim is a thrombopoietin receptor agonist used to treat thrombocytopenia (low platelet count) and is not indicated for anemia.

Correct Answer is B

Explanation

Rationale:

A. Mostly cloudy: This option does not refer to a medication and is therefore irrelevant in this context.

B. Acyclovir: This is the correct medication for treating varicella-zoster virus, as it is an antiviral drug effective in managing symptoms and reducing the duration of the infection.

C. Vancomycin: This antibiotic is used to treat serious bacterial infections and is not indicated for viral infections like varicella-zoster.

D. Gentamicin: This is an aminoglycoside antibiotic that is ineffective against viral infections and is used primarily for bacterial infections.

E. Quinine: This medication is used to treat malaria and is not relevant for varicella-zoster virus treatment.

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