Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who has a prescription for morphine 1 to 2 mg subcut every 4 hr PRN for pain. Which of the following actions should the nurse take?
A. Clarify the dosage of the morphine.
Clarify the dosage of the morphine. Rationale: The dosage of morphine prescribed (1 to 2 mg) is within the acceptable range for subcutaneous administration every 4 hours as needed for pain. There is no need to clarify the dosage since it falls within the prescribed range.
B. Administer up to 2 mg of morphine in 4 hr.
Administer up to 2 mg of morphine in 4 hr. Rationale: The correct action is to administer up to 2 mg of morphine every 4 hours as needed for pain, as per the prescription. This is a standard dosing range for morphine for pain management.
C. Clarify the route of the morphine.
Clarify the route of the morphine. Rationale: The prescription clearly states the route of administration as subcutaneous (subcut). There is no need to clarify the route since it is already specified.
D. Administer 2 mg of morphine every 2 hr.
Administer 2 mg of morphine every 2 hr. Rationale: Administering morphine every 2 hours would exceed the recommended dosing interval and could potentially lead to an overdose or respiratory depression. The prescribed dosing interval is every 4 hours, not every 2 hours.
This question is an excerpt from Nurse Dive's nursing test bank - ATI Custom T1 PM Summer 2023 Proctored Exam 5. Take the full exam now
Full Explanation
he correct answer is:
A. Clarify the dosage of the morphine.
Explanation:
The prescription indicates that the client should receive 1 to 2 mg of morphine subcutaneously every 4 hours as needed for pain. This means that the nurse can administer 1 mg or 2 mg of morphine, but the exact dose should be determined based on the client's pain level and response to the medication. The nurse should clarify with the prescriber to determine the specific dosage range that is appropriate for the client.
The other options are incorrect:
- B. Administer up to 2 mg of morphine in 4 hr: The prescription states that the client can receive up to 2 mg in 4 hours, but the nurse should not administer the maximum dose without first assessing the client's pain level and determining the appropriate dose based on their individual needs.
- C. Clarify the route of the morphine: The prescription clearly states that the morphine should be administered subcutaneously, so there is no need to clarify the route.
- D. Administer 2 mg of morphine every 2 hr: The prescription states that the morphine should be administered every 4 hours, not every 2 hours. Administering the medication more frequently than prescribed could lead to overdose or other adverse effects.
It is important for nurses to carefully review all prescriptions and clarify any uncertainties with the prescriber to ensure that medications are administered correctly and safely.
Similar Questions
A nurse is obtaining an oxygen saturation on a client.
Which of the following actions should the nurse take?
A. Wait 10 sec after placing the probe before obtaining the oxygen saturation reading.
Wait 10 sec after placing the probe before obtaining the oxygen saturation reading. Rationale: Waiting for 10 seconds after placing the oxygen saturation probe is unnecessary and may lead to a delay in obtaining important oxygen saturation information. Typically, oxygen saturation readings are obtained immediately after placing the probe.
B. Place the sensor probe on the same extremity as an electronic blood pressure cuff.
Place the sensor probe on the same extremity as an electronic blood pressure cuff. Rationale: It is generally not recommended to place the oxygen saturation sensor probe on the same extremity as an electronic blood pressure cuff. The pressure from the cuff may interfere with the accuracy of the oxygen saturation reading. It is advisable to place the probe on a different extremity.
C. Relocate the sensor every 8 hrs.
Relocate the sensor every 8 hrs. Rationale: There is no specific guideline that requires relocating the oxygen saturation sensor every 8 hours. The sensor should be left in place as long as it is providing accurate readings and remains well-tolerated by the patient. Frequent repositioning may cause discomfort and skin irritation.
D. Choose a finger with a capillary refill less than 2 sec.
Choose a finger with a capillary refill less than 2 sec. Rationale: It is important to choose a finger with a capillary refill less than 2 seconds when placing the oxygen saturation probe. This helps ensure adequate perfusion and accurate oxygen saturation readings. Capillary refill time is a good indicator of peripheral perfusion.
A nurse is assisting with teaching a newly licensed nurse about pain.
Which of the following is an example of acute pain?
A. Fibromyalgia.
Fibromyalgia. Rationale: Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain and is considered chronic rather than acute. Acute pain is typically of short duration and related to a specific injury or condition.
B. Surgical incision.
Surgical incision. Rationale: A surgical incision represents acute pain because it is a temporary and well-defined source of pain that is expected to resolve as the surgical site heals. Acute pain is often linked to tissue damage and has a clear onset and duration.
C. Peripheral neuropathy.
Peripheral neuropathy. Rationale: Peripheral neuropathy can cause chronic pain due to nerve damage and is not typically considered an example of acute pain. Chronic pain conditions are long-lasting and may not have a specific onset.
D. Rheumatoid arthritis.
Rheumatoid arthritis. Rationale: Rheumatoid arthritis is a chronic autoimmune condition that causes joint inflammation and pain. It is not an example of acute pain, as it is an ongoing condition that can last for years.
A nurse is preparing to administer cefotaxime 100 mg IM to a client.
How many grams (g) should the nurse plan to administer?
A. 10 g.
10 g. Rationale: The prescription is for cefotaxime 100 mg IM. To convert milligrams (mg) to grams (g), you need to divide by 1000. Therefore, 100 mg is equivalent to 0.1 g. Administering 10 grams would be a tenfold overdose.
B. 100 g.
100 g. Rationale: Administering 100 grams of cefotaxime would be a massive overdose. The correct conversion from milligrams to grams is 100 mg = 0.1 g.
C. 0.1 g.
0.1 g. Rationale: The correct conversion from milligrams to grams is 100 mg = 0.1 g. Therefore, the nurse should plan to administer 0.1 grams of cefotaxime, as prescribed.