Pharm Exam HELP!!

[missk88]

Sorry for the urgency, but I have an exam later today and I'm doing review questions, so the sooner I get a second opinion, the better.

here's the question:

"the nurse is caring for a patient who is experiencing serve pain. Morphine sulfate 10 mg IM is ordered every 4 hours as needed. The patient asks the nurse to administer it into an existing IV line because he hates the pain of an IM injection. The nurse should?"

A. Explain to the patient the nurse cannot change the route of a medication and that the patient can receive the medication IM as prescribed now or wait unti the nurse pages the prescriber with the patients request.

B. Administer the medication IM

C. Administer the medication via the IV line

D. Determine if the dose is safe for IV administration and if so administer IV.

I feel like the answer could be A, because I feel like the nurse should double check before she changes the route. However, the part about making a patient in pain wait kind of throws me off.

That's why I feel like it could also be D. But I feel like a nurse MUST verify that the change in route is okay with the prescriber, even if she finds it's okay to do so with her own research? I don't know if by "determining" if the drug is safe that involves checking with the prescriber, but I assume it means it's something she looked up. I feel like technically there should involve dilution of the med if it's going to be given IV, but I'm not sure if that's "implied"

Something about putting 10 mgs of morphine straight into someones vein just seems dangerous, though. Not to mention I feel like the absorption rate of IV would be too much/intense. I don't want to get the patient high! So I'm leaning towards A. But please let me now your thoughts!

[PRNketamine7, BSN, RN]

I would say A. You have to give the med by the route ordered. And as a side note, you can only give meds for the reason ordered. I.e it the order says Tylenol for fever or whatever, than it cannot be given for pain.

You have to follow what the order says or consult the MD

[esmith12]

The answer is A. If the patient requests it to be given another way, you MUST get permission from the doctor. Nurses CANNOT change routes of medications without permission from the prescriber. If the patient wants to wait until you get permission then you would document that the medicine was not given and the reason why. The documentation will cover your behind in case there is ever questions that arise down the road.

[Stoogesfan]

I would choose A...it's my understanding as nurses we cannot change route without an order.

[Esme12, ASN, BSN, RN]

NEVER!!!! change a med dose, amount, or route without an MD order.

The actual dosage of morphine IV at one time is 1-4 mgs....not 10.

[brillohead, ADN, RN]

A is also correct because she's not FORCING the patient to wait in pain... she's giving him the option to get the IM as ordered *or* wait for the HCP to call back.

Patients always have the right to refuse treatment -- the patient can refuse the IM injection IF THEY CHOOSE TO. But patients do NOT have the right to change the prescribed route of administration -- that is ONLY for the prescribing HCP to decide.

[alyiana]

Choice A gives the patient a choice. I can give this to you now as ordered or you can wait and I can see about getting a change. This leads way to the unspoken 3rd option. I can give it to you know and see about changing it for the next dose.

[sunflowerlamb]

A, you can not write or change prescriptions.

[nurseprnRN, BSN, RN]

Reassuring to see so many correct answers and rationales. You can only give it by the route it's ordered for, the patient has a lot of choices BUT NOT THIS ONE, and 10mg IVP would be a pleasant trip (and if he's not opioid-naive, maybe not harmful) but it's not your call. :)