can't find the prioritization answer - page 2

1. 
   Nov 17, '12

   2. Resp rate dropping is alarming with morphine.
2. 
   Nov 17, '12

   I ran into this kind of question before....the answer is 2. The scenario is, Morphine was given via I.V. and we all know that if we give Morphine, one thing we have to watch out for is resp. distress. I probably need to start doing something right away with that resp (12) because I don't know what's going to happen within another 5 mins.
3. 
   Nov 17, '12

   Quote from Helenz

   Q:
   you have give Morphine sulfate 4mg IV to a client who has an acute MI. when you evaluate the client's response 5 mins after giving the medication, which of these indicates a need for immediate further actions?
   
   A:
   1. the blood pressure decreases from 114/65 to 106/58 mm Hg.
   2. the respiratory rate drop from 18 to 12 breaths/min.
   3. the cardiac monitor indicates sinus rhythm at a rate of 96 beats/min.
   4. the client still has chest pain at level of 1(on a scale of 0 to 10)
   
   anyone who can help me find the right answer? and why ?

   Answer is 4 there should be NO pain!
4. 
   Nov 17, '12

   Quote from NurseAsh87

   If the pt. is still having pain it's your priority to get it to 0.

   That's not at all true. It may not be possible to eliminate pain in all patients. Your goal is to get the pain to a tolerable level.
5. 
   Nov 17, '12

   Quote from shergillnav

   i took this q and its correct answer is 4 becuse goal is to eliminate pain comletely...if patient show 1 on sacle it mean he /she still have blood deprived to mycordaial muscle ....purpose is ti pain scale should be 0

   While morphine helps reduce myocardial oxygen demands, it's also a narcotic pain medication. Taking away the patient's perception of pain does not mean the cause of the pain is corrected. Giving a patient with a broken leg morphine will not heal their broken leg and giving a patient with an acute MI morphine will not open the occluded vessels causig impaired blood flow.
6. 
   Nov 17, '12

   I saw the rationale and the correct answer is number 4...It's under priority question.Goal in pain management for the client with an acute MI is to completely eliminate the pain.Even pain rated at a level of 1 out of 10,should be treated with additional morphine(possibly lower dose)......choices 1,2 and 3 are possible adverse reactions but most priority in an acute MI is to eliminate the pain completely.
7. 
   Nov 17, '12

   Quote from mariebailey

   What a/b the #1, BP? I know it's only a small dip, but hypotension = decreased perfusion, which is a SE of morphine. This is undesirable during an acute MI.

   This blood pressure is completely normal and nowhere near low enough to cause inadequate perfusion. The BP dropped only 8 points systolic and 7 diastolic. This is not a significant change. Morphine is also a vasodilator, which will reduce blood pressure by reducing systemic vascular resistance. While a significant drop in a patient with a MI might be a problem, a drop this slight is not a concern.
8. 
   Nov 17, '12

   I found the question and rationale online. It does say the answer is D. Unfortunately I can't copy and paste the rationale from my phone. I stand corrected. Although, this isn't the first question that I have disagreed with.
9. 
   Nov 17, '12

   I think many posters need to go back and look at the time frame that was given. FIVE MINUTES. A drop from 18 breaths/min to 12 breaths/min in only five minutes is pretty significant.
10. 
    Nov 17, '12

    2 is the ans use decision tree
11. 
    Nov 17, '12

    Oh heck, let's call Aunt Marlene (Hurst)! LOL
12. 
    Nov 17, '12

    2 would be the answer because pain is NEVER a life threatening condition. If you had pain of 8/10 and a respiratory rate of 12, the respiratory rate would be the most crucial. The #1 thing that you look for with ANY narcotic pain relief if respiratory depression
13. 
    Nov 17, '12

    2 is my answer and 4 is nclex answer.

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