Hold and report respiratory rate below 12 or oxygen saturation drop (respiratory depression).
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is preparing morphine for a client and notices the order reads 'morphine 2 mg IV.' The vial contains 4 mg per mL. How many milliliters should the nurse prepare?
Answer: B. Using the formula desired over have times the volume: 2 mg divided by 4 mg per mL equals 0.5 mL. Accurate calculation prevents a dangerous overdose. The other volumes would deliver an incorrect, potentially harmful dose.
Question 2 of 5
A nurse is assessing a client 30 minutes after giving IV morphine for severe pain. Which finding best indicates the medication was effective?
Answer: A. Evaluating effectiveness means comparing the pain rating before and after. A decrease in the self-reported pain score (for example from 8 to 3) is the best evidence of analgesic efficacy. A stable blood pressure, the client falling asleep, or a normal temperature do not directly measure pain relief.
Question 3 of 5
An order reads: morphine 2 mg IV. The vial contains 10 mg in 1 mL. How many milliliters should the nurse administer?
Answer: A. Volume = desired / available x quantity: (2 / 10) x 1 = 0.2 mL. The other answers come from inverting the ratio or a decimal error.
Question 4 of 5
A nurse is reviewing a new prescription for an opioid in a client with chronic kidney disease. Which opioid is generally preferred because its metabolites do not accumulate significantly in renal impairment?
Answer: A. Fentanyl is often preferred in renal impairment because it lacks active metabolites that accumulate. Morphine produces metabolites (such as morphine-6-glucuronide) that build up and cause toxicity in kidney disease, and meperidine accumulates neurotoxic normeperidine; codeine is also problematic. The nurse anticipates fentanyl as the safer option.
Question 5 of 5
An order reads morphine 0.05 mg/kg IV every 4 hours as needed for a child weighing 20 kg. What is the single dose?
Answer: B. 20 kg times 0.05 mg/kg equals 1 mg per dose. Precise decimal handling is essential because opioids are high-alert medications.
Keep the streak going with more questions like these, each with a full rationale.
What is morphine?
It relieves pain, reduces anxiety, and decreases cardiac workload by venous dilation. Key principle: the priority risk is respiratory depression; naloxone is the antidote.
Key points to remember
- The most dangerous adverse effect is respiratory depression; assess respiratory rate before each dose.
- Naloxone is the reversal agent for opioid overdose.
- Common effects include constipation, sedation, urinary retention, hypotension, and pinpoint pupils.
- In MI it decreases preload and myocardial oxygen demand in addition to relieving pain.
- Constipation does not resolve with tolerance, so a bowel regimen is needed.
Nursing priorities
- Assess respiratory rate and sedation level before and after administration; hold if respirations are below 12.
- Keep naloxone available for opioid-induced respiratory depression.
- Implement a bowel regimen and monitor for constipation and urinary retention.
- Assess pain using a standardized scale and reassess after dosing.
- Use fall precautions because of sedation and hypotension.
Patient teaching
- Report pain that is not controlled and any trouble breathing.
- Increase fluids and fiber to prevent constipation.
- Change positions slowly and avoid driving or alcohol while taking it.
Red flags: report now
- Hold and report respiratory rate below 12 or oxygen saturation drop (respiratory depression).
- Report pinpoint pupils with decreased level of consciousness (overdose).
- Never give to a patient who is already heavily sedated.
References
Clinical references for this topic
