Question

a client is prescribed morphine 1 mg iv per hour basal rate with 1 mg iv every 15 minutes per patient - controlled analgesia (pca) pump for a total of 5 mg iv maximally per hour. which nursing action has the highest priority before initiating the pca pump?

a assessment of the clients subjective and objective signs of pain.

b assessment of the rate and depth of the clients respirations.

c assessment of the type of anesthesia used during the surgical procedure.

d assessment of the expiration date on the morphine syringe in the pump.

Explanation:

Morphine is an opioid that can cause respiratory depression, a life - threatening side effect. Before initiating a PCA pump with morphine, the highest priority nursing action is to assess the client's respiratory status (rate and depth of respirations) to ensure the client can tolerate the medication and to monitor for potential respiratory depression. Assessing pain (option A) is important but not the highest priority for safety. Assessing the type of anesthesia (option C) and the expiration date of the morphine syringe (option D) are not as critical as assessing respiratory status for immediate patient safety.

Answer:

B. Assessment of the rate and depth of the client’s respirations.