Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
QUESTION 1 | MCQ
Clinical Scenario:
A 72-year-old male patient with a history of chronic obstructive
pulmonary disease (COPD), benign prostatic hyperplasia, and
osteoarthritis is admitted to the medical-surgical unit following
total hip replacement surgery. The patient reports severe pain
rated 8/10 on the numeric rating scale. The healthcare provider
orders morphine sulfate 4 mg intravenous push every 4 hours
as needed for breakthrough pain.
,Question Stem:
The nurse should prioritize which of the following assessments
before administering this dose of morphine sulfate?
Answer Options:
A. Serum creatinine and blood urea nitrogen levels
B. Respiratory rate, depth, and oxygen saturation
C. Blood pressure and heart rate
D. Urinary output and bladder scan results
Correct Answer: B. Respiratory rate, depth, and oxygen
saturation
Comprehensive Rationale:
The correct answer is B because morphine sulfate is a potent
opioid agonist that acts primarily on mu-opioid receptors in the
brain and spinal cord. A significant pharmacodynamic effect of
morphine is respiratory depression through direct action on the
medullary respiratory center, reducing both the sensitivity of
the respiratory center to carbon dioxide and the respiratory
drive. In this 72-year-old patient with COPD, the risk of
respiratory depression is substantially elevated due to age-
related decreased pulmonary function, baseline respiratory
compromise, and increased sensitivity to opioids in older
adults.
,Before administering any opioid, the nurse must perform a
comprehensive respiratory assessment including rate, depth,
rhythm, and oxygen saturation. The patient's baseline
respiratory status should be established and monitored
throughout therapy. The nurse should hold the dose and notify
the healthcare provider if the respiratory rate is below 12
breaths per minute or if oxygen saturation drops below 92%, as
these parameters indicate potentially dangerous respiratory
depression.
Pharmacokinetic considerations: Morphine undergoes
extensive first-pass metabolism in the liver via glucuronidation
to active metabolites (morphine-6-glucuronide and morphine-
3-glucuronide). In older adults, decreased hepatic blood flow
and reduced renal clearance can lead to drug accumulation and
increased risk of adverse effects. The intravenous route
provides rapid onset of action (5-10 minutes) with peak effect in
20-30 minutes, making continuous monitoring essential.
Nursing Process Integration:
Assessment - The primary nursing process component
addressed is Assessment. The nurse must collect
comprehensive data including respiratory status, pain
characteristics, vital signs, medication history, and baseline
functional status before medication administration. This
, assessment guides safe implementation and subsequent
evaluation of therapeutic outcomes.
Distractor Analysis:
A. Serum creatinine and blood urea nitrogen levels:
Why It Is Incorrect: While renal function assessment is
important for morphine dosing because active metabolites are
excreted renally, it is not the priority assessment before the first
dose in an acute pain scenario. Renal function should be
reviewed as part of the overall assessment but does not take
precedence over respiratory evaluation.
Common Clinical Misconception: Nurses may believe that
because morphine is metabolized by the liver and excreted
renally, renal function is the priority. However, the immediate
safety concern is respiratory status.
Potential Medication Safety Risk: Focusing on laboratory values
while delaying respiratory assessment could result in
administering morphine to a patient with unrecognized
respiratory compromise, potentially leading to severe
respiratory depression.
Appropriate Nursing Action: Review renal function tests as part
of the complete assessment, but prioritize respiratory
assessment before administration. If renal impairment is
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
QUESTION 1 | MCQ
Clinical Scenario:
A 72-year-old male patient with a history of chronic obstructive
pulmonary disease (COPD), benign prostatic hyperplasia, and
osteoarthritis is admitted to the medical-surgical unit following
total hip replacement surgery. The patient reports severe pain
rated 8/10 on the numeric rating scale. The healthcare provider
orders morphine sulfate 4 mg intravenous push every 4 hours
as needed for breakthrough pain.
,Question Stem:
The nurse should prioritize which of the following assessments
before administering this dose of morphine sulfate?
Answer Options:
A. Serum creatinine and blood urea nitrogen levels
B. Respiratory rate, depth, and oxygen saturation
C. Blood pressure and heart rate
D. Urinary output and bladder scan results
Correct Answer: B. Respiratory rate, depth, and oxygen
saturation
Comprehensive Rationale:
The correct answer is B because morphine sulfate is a potent
opioid agonist that acts primarily on mu-opioid receptors in the
brain and spinal cord. A significant pharmacodynamic effect of
morphine is respiratory depression through direct action on the
medullary respiratory center, reducing both the sensitivity of
the respiratory center to carbon dioxide and the respiratory
drive. In this 72-year-old patient with COPD, the risk of
respiratory depression is substantially elevated due to age-
related decreased pulmonary function, baseline respiratory
compromise, and increased sensitivity to opioids in older
adults.
,Before administering any opioid, the nurse must perform a
comprehensive respiratory assessment including rate, depth,
rhythm, and oxygen saturation. The patient's baseline
respiratory status should be established and monitored
throughout therapy. The nurse should hold the dose and notify
the healthcare provider if the respiratory rate is below 12
breaths per minute or if oxygen saturation drops below 92%, as
these parameters indicate potentially dangerous respiratory
depression.
Pharmacokinetic considerations: Morphine undergoes
extensive first-pass metabolism in the liver via glucuronidation
to active metabolites (morphine-6-glucuronide and morphine-
3-glucuronide). In older adults, decreased hepatic blood flow
and reduced renal clearance can lead to drug accumulation and
increased risk of adverse effects. The intravenous route
provides rapid onset of action (5-10 minutes) with peak effect in
20-30 minutes, making continuous monitoring essential.
Nursing Process Integration:
Assessment - The primary nursing process component
addressed is Assessment. The nurse must collect
comprehensive data including respiratory status, pain
characteristics, vital signs, medication history, and baseline
functional status before medication administration. This
, assessment guides safe implementation and subsequent
evaluation of therapeutic outcomes.
Distractor Analysis:
A. Serum creatinine and blood urea nitrogen levels:
Why It Is Incorrect: While renal function assessment is
important for morphine dosing because active metabolites are
excreted renally, it is not the priority assessment before the first
dose in an acute pain scenario. Renal function should be
reviewed as part of the overall assessment but does not take
precedence over respiratory evaluation.
Common Clinical Misconception: Nurses may believe that
because morphine is metabolized by the liver and excreted
renally, renal function is the priority. However, the immediate
safety concern is respiratory status.
Potential Medication Safety Risk: Focusing on laboratory values
while delaying respiratory assessment could result in
administering morphine to a patient with unrecognized
respiratory compromise, potentially leading to severe
respiratory depression.
Appropriate Nursing Action: Review renal function tests as part
of the complete assessment, but prioritize respiratory
assessment before administration. If renal impairment is
