Pharmacology exam 2 Chamberlain

a nurse is admitting a client who is having an exacerbation of his asthma. when reviewing the providers orders, the nurse recognizes that clarification is needed for which of the following medications?

propanolol

a nurse is teaching a client about taking an expectorant to treat a cough. the nurse should explain that this type of medication has which of the following?

stimulates secretions

Naloxone is an antidote to what?

opioid

what is diazepam used for?

patients who are experiencing alcohol withdraw

opioid addiction

A pattern of compulsive use of opioids or any other addictive substance characterized by a continuous craving for the substance and the need to use it for effects other than pain relief (also called addiction).

A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric coated aspirin PO once daily. The client asks of the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide? "Crushing the medication might cause you to have a stomach ache or indigestion" "Crushing the medication is a good idea, and I can mix it in some ice cream for you" "Crushing the medication would release all the medication at once, rather than over time" "Crushing is unsafe, as it destroys the ingredients in the medication"

"Crushing the medication might cause you to have a stomach ache or indigestion" The nurse will respond with "crushing the medication might cause you to have a stomach ache or indigestion" because the medication will dissolve in the stomach instead of the intestine. (Potter, 2016) Enteric coated tablets dissolve too quickly if administered with milk and should not be crushed or chewed up. (Pearson, 2016)Sustained release contains small particles of a medication coated with material that requires a varying amount of time to dissolve.

a nurse is evaluating teaching on a client who has a new prescription for montelukast to treat asthma. which of the following statements by the client indicates an understanding of the teaching?

"ill take this medication once a day in the evening"

education to provide to your patients about taking sertraline

-Take as directed -Do not double dose -Avoid driving until effects of rx are known -Advise patient, family, caregivers to look for suicidality, especially during early therapy. -Notify HCP if experiencing thoughts of suicide.

A nurse is providing information to a client who has early Parkinson's disease and a new prescription for pramipexole. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A. hallucinations B. Increased salivation C. Diarrhea D. Discoloration of urine

A. hallucinations

Bupropion know most common side effects and how long it takes to become effective.

Agitation, headache, dry mouth, nausea, vomiting, tremor. May show improvement within the first 1-2 weeks; may need up to 6-8 weeks to fully improve.

How does heparin work?

Heparin works quickly. Can only be given via IV or subq. Anticoagulant = anti clotting factors. Blocks formation of fibrin. Withholding clotting factors. Prevention of new clots and prevention of growth of existing clots. *It does NOT dissolve clots!*

Gabapentin (Neurontin) side effects and indication use for psych health and pain.

Indication: Partial seizures; Postherpetic neuralgia; Restless legs syndrome; Neuropathic pain; Bipolar disorder; Anxiety; Diabetic peripheral neuropathy. Adverse reactions: Suicidal thoughts, Rhabdomyolysis, hypersensitivity reactions Common side effects; Confusion, depression, dizziness, drowsiness *Don't drink alcohol* Alcohol -> Additive CNS depression -> Increased CNS depression

Warfarin therapy for atrial fibrillation, why? Safety precautions and labs.

It stops blood clotting! Labs: INR: 2-3 (therapeutic range) / 2.5-3.5 (heart valve replacements) Antidote: Vitamin K Safety precautions: Keep K consistent (with food). Antibiotics increase risk for bleeding. Taken lifelong to prevent clots with atrial fibrillation or mechanical valve replacements. Vitamin K foods: Liver, leafy green vegetables.

what lab results indicate patient is at risk for anemia

Low iron, Hemoglobin or hematocrit, or Mean Corpuscular Volume (MCV)

what should you keep on you when administering morphine via IV?

Naloxone

What class of medication is sertraline and how long does it take to be effective?

Selective serotonin reuptake inhibitors (SSRI) It usually takes about 4-6 weeks to work.

a nurse is providing teaching for a client who has a new prescription for metformin. Which of the following findings should the nurse instruct the client to report as an adverse effect of metformin? a. somnolence b. Constipation C. Fluid retention D. Weight gain

a. somnolence

acetylcysteine is an antidote to what?

acetominophen

A nurse is preparing to administer morphine IV to a client. Which of the following medications should the nurse plan to have available? a. Flumazenil b. Naloxone c. Promatine d. Neostigime

b. Naloxone Rationale: The nurse will plan to have naloxone available when administering morphine to a client. Morphine is an opioid analgesic and naloxone counteracts the morphine. Flumazenil is benzodiazepine antagonist. Promatine is used to treat orthostatic hypotension. Neostigime is used to prevent and treat postoperative abdominal distention and urinary retention. (Pearson, 2016)

a nurse is planning care for a client who is being treated with chemotherapy and radiation for metastatic breast cancer. the patient has neutropenia. which of the following should the nurse include in the restrictions in the clients plan of care? a. all visitors from entering the room b. fresh flowers and potted plants in the room c. oral fluid intake between meals only d. activities that could result in bleeding

b. fresh flowers and potted plants in the room

a nurse if teaching a client who has a new prescription for codeine. which of the following instructions should the nurse include in the teaching? a. "you should take the medication on an empty stomach to prevent nausea" b. "you should limit alcohol intake to 12 ounces daily" c. you should expect to experience diarrhea while taking this medication" d. "you should change positions slowly"

d. "you should change positions slowly" rationale: codeine is an opioid analgesic and causes CNS depression and orthostatic hypertension

protamine is an antidote to what?

heparin

What lab results indicate patient is at risk for bleeding

Too few platelets may impair blood clotting. A high number of platelets (thrombocytosis) can lead to excessive blood clotting in small blood vessels, especially those in the heart or brain. The most common of these tests are the prothrombin time (PT) and the partial thromboplastin time (PTT). The levels of individual clotting factors can also be determined.

Ferrous sulfate liquid, IM and IV. Teaching points.

Treat/prevent iron deficiency anemia. Liquid: Mix liquid with water or juice and drink it from a straw for less stains on your teeth. Rinse your mouth. IM: Z-track method IV: Patients who receive IV iron usually do so because they cannot take oral iron.

Discuss nursing interventions and educational points for Thrombocytopenia

Use caution with skin and mouth care. Use a soft, gentle toothbrush. Avoid contact sports, or any activity that may cause scratches or bruises.

A nurse is monitoring a client who took an overdose of acetaminophen 72 hours ago. The nurse should identify which of the following findings as a manifestation of acetaminophen poisoning? a. Constipation b. Xerostomia (dry mouth) c. Tinnitus (ringing in the ear) d. Vomiting

d. Vomiting Rationale: The nurse should identify vomiting as a manifestation of acetaminophen poisoning. Constipation, xerostomia, and tinnitus are adverse effects of medications, but not for acetominophen

A nurse is caring for a client who is taking naproxen following an exacerbation of rheumatoid arthritis. Which of the following statements by the client requires further discussion by the nurse? "I signed up for swimming class" "I've been taking an antacid to help with indigestion" "I've lost 2 pounds since my appointment 2 weeks ago" "The naproxen is easier to take when I crush it and put it in applesauce"

"I've been taking an antacid to help with indigestion" rationale: "I've been taking an antacid to help with indigestion" will require the nurse to have further discussion with the client. Frequent indigestion is a sign of GI ulceration and needs to be promptly reported to the provider. (Pearson, 2016) For people with RA, exercise is so beneficial it's considered a main part of RA treatment. The exercise program should emphasize low-impact aerobics, muscle strengthening and flexibility. Anti-inflammatory diet and healthy eating reduces weight. (RA, 2018) Some medications can be crushed and mixed with pureed foods if necessary (Potter, 2016)

A nurse is providing instructions to a client who has a new prescription for albuterol, PO. Which of the following instructions should the nurse include? "You can take this medication to abort an acute asthma attack." "Tremors are an adverse effect of this medication." "Prolonged use of this medication can cause hyperglycemia." "This medication can slow skeletal growth rate."

"Tremors are an adverse effect of this medication."

A nurse is teaching a client who has a new prescription for codeine. Which of the following instructions should the nurse include in the teaching? a. "You should take the medication on an empty stomach to prevent nausea" b. "You should limit alcohol intake to 12 ounces daily" c. "You should expect to experience diarrhea while taking this medication" d. "You should change positions slowly"

"You should change positions slowly" rationale: The nurse will instruct the patient to change position slowly. Codeine should be administered with food. Patients should not consume any alcohol. Constipation should be expected from codeine

opioid tolerance

A normal physiologic condition that results from long-term opioid use, in which larger doses of opioids are required to maintain the same level of analgesia and in which abrupt discontinuation of the drug results in withdrawal symptoms (same as physical dependence).

A nurse is preparing to administer an opioid agonist to a client who has acute pain. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? A. Urinary retention B. Tachypnea C. hypertension D. Irritating cough

A. Urinary retention

A nurse is teaching a client who has a prescription for long‐term use of oral prednisone for treatment of chronic asthma. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication? A. Weight gain B. Nervousness C. Bradycardia D. Constipation

A. Weight gain

What can you teach a patient about taking diazepam Valium? Why is it used for CIWA (clinical institute withdrawal assessment for alcohol)?

Acts fast Highly addictive, hard to come off Not safe for long-term use Highly sedative Do not skip doses ***NO ALCOHOL*** Its active metabolites help smooth the course of withdrawal and limit breakthrough symptoms; however, prolonged sedation is a risk. It helps to control agitation associated with alcohol withdrawal.

A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching? Take the albuterol at the same time each day. Administer the albuterol inhaler prior to using the beclomethasone inhaler. Use beclomethasone if experiencing an acute episode. Avoid shaking the beclomethasone before use.

Administer the albuterol inhaler prior to using the beclomethasone inhaler.

Acetaminophen (Tylenol) max daily dose to avoid toxicity and clinical manifestations of toxicity?

Adults: The recommended dose of acetaminophen in adults is 650 to 1,000 mg every 4 to 6 hours, *not to exceed 4,000 mg in a 24-hour period.* Children: In children, the recommended dose is 10 to 15 mg/kg every 4 to 6 hours, *not to exceed 50 to 70 mg/kg in 24 hours.*

What should you as the nurse assess of your patient prior to the administration of morphine?

Assess risk for opioid addiction, abuse, or misuse prior to administration Assess level of consciousness, BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Assess type, location, and intensity of pain prior to and 1 hr following PO, subcut, IM, and 20 min (peak) following IV administration

Flumazenil is an antidote to what?

Benzodiazepine

A nurse is caring for a client who is receiving heparin by continuous IV infusion. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? A. Vitamin k1 B. Atropine C. Protamine D. Calcium gluconate

C. Protamine

a nurse is teaching clients about the use of insulin to treat type 1 diabetes mellitus. For which of the following types of insulin should the nurse tell the clients to expect a peak effect 1 to 5 hr after administration? a. insulin glargine b. NPH insulin C. Regular insulin D. insulin lispro

C. Regular insulin

A nurse is teaching a client who has a new prescription for levodopa/carbidopa for Parkinson's disease. Which of the following instructions should the nurse include? A. Increase intake of protein‐rich foods. B. Expect muscle twitching to occur. C. Take this medication with food. D. Anticipate relief of manifestations in 24 hr.

C. Take this medication with food.

Discuss nursing interventions and educational points for neutropenia

Can't fight infections as well as others. Engage in good hygiene, safe practices and be cautious of illnesses. Hand washing and oral care. Avoid crows and others who are ill. Avoid uncooked meats, seafood, eggs and unwashed fruits and vegetables. Procedures that break the skin such as venipunctures, biopsies and I.V. therapy may also introduce infection. Don't use catheters, enemas, rectal suppositories, rectal thermometers.

Write a general list of possible adverse effects or side effects of chemotherapy?

Chemo brain (foggy thinking) Anxiety and depression Hot flashes Weak heart (chemo affects heart muscle) Nausea & vomiting Discolored and cracked nails Loss of appetite Hair loss Mouth sores Lower blood count: low platelets Digestive stress: constipation, diarrhea, weight loss, weakness Decreased urination Red urine: drugs leaving system Bone loss

What instructions would you give to your patient about taking NSAIDs?

Do not use an over-the-counter NSAID for longer than 10 days. The most common side effects from NSAIDs are stomach aches, heartburn, and nausea. NSAIDs may irritate the stomach lining. Patients taking these drugs long term should be monitored periodically for signs of blood loss, renal dysfunction, and hepatic dysfunction. Common complications: Edema, nausea, gastric ulceration, bleeding, renal toxicity

How does expectorants work?

Drugs that increase the flow of fluid in the respiratory tract, usually by reducing the viscosity of secretions, and facilitate their removal by coughing.

Discuss nursing interventions and educational points for Anemia

Eat iron rich foods, such as meat, chicken, fish, eggs. Vitamin C helps absorb iron.

Prednisone- Indications, side effects, mechanism of action, and Clinical Manifestations of withdrawal symptoms

Indication: Corticosteroid. It prevents the release of substances in the body that cause inflammation. It also suppresses the immune system. Prednisone is used as an anti-inflammatory or an immunosuppressant medication. Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders. Adverse effects: Rapid weight gain, blurred vision, sepsis, osteoporosis, sleep problems. Common side effects: Increased appetite, nausea, stomach pain, slow wound healing. Mechanism of action: Decreases inflammation via suppression of the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Clinical manifestations of withdrawal symptoms: Severe fatigue. Weakness. Body aches. Joint pain. Nausea.

Carbidopa-levodopa side effects, indication?

Indication: Intermittent treatment of "off" episodes in patients with Parkinson's disease treated with carbidopa/levodopa. Side effects: Aggression, agitation, confusion, delirium, delusions, disorientation, hallucinations, headache, insomni, psychosis *Additional notes*: Levodopa is in a class of medications called central nervous system agents. It works by being converted to dopamine in the brain. Carbidopa is in a class of medications called decarboxylase inhibitors. It works by preventing levodopa from being broken down before it reaches the brain. Carbidopa prevents the nausea that can be caused by levodopa alone. Carbidopa is also a levodopa enhancer.

Diphenhydramine, different indications and beneficial use? What are the side effects and safety precautions?

Indications: Relief of allergic symptoms caused by histamine release including: Anaphylaxis, Seasonal and perennial allergic rhinitis, Allergic dermatoses. Parkinson's disease and dystonic reactions from medications. Side effects: Drowsiness, dizziness, headache, paradoxical excitation (increased in children), blurred vision, tinnitus. Safety precautions: May cause drowsiness-avoid driving or other activities requiring alertness until response to drug is known. Use sunscreen and protective clothing to prevent photosensitivity reactions Avoid use of alcohol and other CNS depressants Avoid OTC cough and cold products while breastfeeding or to children <4 yr. Avoid OTC products that contain diphenhydramine due to increased sensitivity to anticholinergic effects.

How does lithium toxicity occur? Side effects of lithium toxicity?

Occurs with high levels of serum concentrations. Serum concentrations should not exceed 1.5 mEq/L. Side effects: Excessive urination & extreme thirst Vomiting & diarrhea: adds more dehydration Neuromuscular excitability: tremors/myoclonic jerks Ataxia, confusion, agitation Nursing interventions: Increase fluids *NO NSAIDS* : decrease renal blood flow, increase r/f toxicity

How will you as the nurse teach your client who has asthma about how to use an albuterol inhaler?

Shake the metered dose inhaler gently Remove the cap and inspect mouthpiece to ensure no foreign objects Hold the inhaler upright and grasp it with the thumb and first two fingers. Tilt the patients head back slightly Hold either 1-2 in. away from mouth, or place mouthpiece fully in mouth. Exhale completely, then press down once on the inhaler to release the medication; have the pt breathe in slowly and deeply for 5 sec. Have pt. Hold breath for 10 seconds then exhale slowly through the nose or pursed lips.

A nurse is caring for a client who is to start therapy with ibuprofen for hip pain. Which of the following information should the nurse provide about ibuprofen? Take the medication with an aspirin to increase effectiveness Take the medication with food Taking the maximum dose will offer stroke prevention Sustained release forms maybe be crushed for easier administration

Take the medication with food rationale: The nurse will advise the client to take ibuprofen with food, milk or an 8 oz glass of water to reduce gastric discomfort. The nurse will advise the client not to take ibuprofen concurrently with aspirin. The nurse will teach the patient to take the smallest effective dose for clients who have cardiovascular disease. The nurse will instruct the client not to chew or crush enteric coated or sustained release tablets

A nurse is teaching a client who has a new prescription for ibuprofen to treat hip pain. Which of the following instructions should the nurse include in the teaching? Expect ringing in the ears Take the medication with food Store the medication in the refrigerator Monitor for weight loss

Take the medication with food rationale: The nurse will advise the client to take ibuprofen with food, milk or an 8 oz glass of water to reduce gastric discomfort. The nurse will advise the client to notify the provider and stop the medication if ringing in the ears occur. (ATI, 2016) Store the medication in tightly closed, light resistant container unless otherwise directed by manufacturer (Pearson, 2016) Monitor for weight gain from fluid retention due to impaired kidney function

A hospice nurse is caring for a client who has terminal cancer and takes PO morphine for pain relief. The client reports that he had to increase the dose of morphine this week to obtain relief. Which of the following scenarios should the nurse document as the explanation for this situation? The client not been taking the medication properly The client is experiencing episodes of confusion The client has become addicted to the medication The client developed a tolerance to the medication

The client developed a tolerance to the medication rationale: the nurse will document that the client developed a tolerance to the medication. Overtime, tolerance develops to the analgesic effects of opioids, necessitating dose escalation to achieve pain relief. There is no evidence that the client has not been taking the medication improperly. Confusion is a side effect of morphine, but not an explanation for the situation. Addiction associated with chronic persistent pain range from 6% to 10%.

What lab results indicate patient is at risk for infection

WBC (leukocytes) fight bacteria, viruses and other organisms your body identifies as danger. A higher than normal amount of WBCs in your blood could mean that you have an infection. Too few WBC's can indicate you're at risk for developing an infection. Neutrophil levels are low

A nurse is planning to administer morphine IV to a client who is postoperative. Which of the following actions should the nurse take? Monitor for seizures and confusion with repeated doses. Protect the client's skin from the severe diarrhea that occurs with morphine. Withhold this medication if respiratory rate is less than 12/min. Give morphine intermittent via IV bolus over 30 seconds or less.

Withhold this medication if respiratory rate is less than 12/min.

A nurse is preparing to administer a medication to a client who states "that looks different from the pill I usually take". Which of the following responses should the nurse take? a. "Describe what the pill looks like" b. "This is the medication prescribed by your provider" c. "This pill is probably from a different lot number than yours at home" d. "The hospital might use a different manufacturer, but the medication is the same"

a. "Describe what the pill looks like" rationale: The nurse will ask what the pill looks like. To prevent medication errors, the nurse should address the patient's concerns about the medications before administering them. The other options are not addressing the patient's concerns, involving the patient or educating the patient

a nurse is caring for a client who has breast cancer and asks why the treatment plan contains a combination therapy of cyclophosphamide, methotrexate, and fluorouracil. the response by the nurse should include that combination chemotherapy is used to do which of the following? (select all that apply.) a. Decrease medication resistance b. attack cancer cells at different stages of cell growth c. Block chemotherapy agent from entering healthy cells d. stimulate immune system e. Decrease injury to normal body cells

a. Decrease medication resistance b. attack cancer cells at different stages of cell growth e. Decrease injury to normal body cells

A nurse is assessing a client who reports acute pain. The nurse should anticipate which of the following findings? a. Increased heart rate b. Decreased respiratory rate c. Hyperactive bowel sounds d. Decreased blood pressure

a. Increased heart rate rationale: The nurse should anticipate increased heart rate with acute pain. The nurse should also anticipate increased respiratory rate, decreased gastrointestinal motility, and elevated blood pressure

A nurse is caring for a 4-year old child who is resistant to taking medication. Which of the following strategies should the nurse use to elicit the child's cooperation? a. Offer the child a choice of taking the medication with juice or water b. Tell the child it is candy c. Hide the medication in a large dish of ice cream d. Tell the child he will have to have a shot instead

a. Offer the child a choice of taking the medication with juice or water rationale: The nurse will offer the child a choice of taking medication with juice or water. Providing a child with choices when possible can result in greater success. (Potter, 2017) Telling the child it is candy and hiding the medication can hinder patient nurse relationship. Telling the child he will have a shot might cause the child to be uncooperative.

a nurse is admitting a client to the hospital following acetaminophen toxicity. which of the following medications should the nurse administer to the client? a. acetylcysteine b. pegfilgrastim c. misoprostol d. naltrexone

a. acetylcysteine

A nurse is teaching a class about safe medication administration. The nurse should include in the teaching that which of the following references are acceptable for safe medication administration? a. A website that ends in .com b. Published journal c. Pharmacists d. Physicians' desk reference e. Pharmaceutical sales representatives

b. Published journal c. Pharmacists d. Physicians' desk reference e. Pharmaceutical sales representatives Rationale: The nurse will teach her class that using appropriate resources such as a published journal, pharmacists, Physician's Desk Reference, and pharmaceutical sales representatives will reduce medication errors. (ATI, 2016) A website that ends in .com does not always provide accurate information.

A charge nurse is supervising a newly licensed nurse provide care for a client who has a PCA pump. Which of the following statements made by the nurse requires further action by the charge nurse? a. "I discarded the remaining 2 milligrams of morphine from the PCA pump. Please document that you witnessed it" b. "I noted that my client pushed the PCA button six times in the last hour, and the PCA lockout is set for 10 minutes" c. "I gave my client a bolus dose of morphine when I initiated the PCA pump" d. "I told the client's family that they must not push the PCA button for the client"

c. "I gave my client a bolus dose of morphine when I initiated the PCA pump" rationale: "I gave the client a bolus of morphine when I initiated the PCA pump" requires action from the charge nurse to the newly licensed nurse. Programming of settings usually requires independent verification by two nurses to ensure accuracy and correct orders by the doctor. The PCA pump are designed to deliver a specific dose, which is programmed to be available at specific time intervals. Family members and visitors must be instructed not to push the button for the patient as this bypasses the safety feature of PCA, which requires an awake patient to activate the device.

A nurse is caring for a client who is postoperative following abdominal surgery and reports incisional pain. The surgeon has prescribed morphine 4 mg IV bolus every 6 hr as needed. Before administering this medication, the nurse should complete which priority assessment? a. Blood pressure b. Apical heart rate c. Respiratory rate d. Temperature

c. Respiratory rate rationale: The nurse assess the client's respiratory rate, as a priority, prior to the administration of morphine since morphine produces respiratory depression. Blood pressure, apical heart rate, and temperature should be assessed, but not the priority.

A charge nurse is observing a newly licensed nurse administer medications to a client. Which of the following actions by the newly licensed nurse should prompt the charge nurse to intervene? a. Verifies the medication against the prescription and medication label b. Scans the bar code on the medication administration record and the client's arm band c. Checks the provider's orders and confirmed dosage in a medication reference guide d. Documents medication administration prior to administering it

d. Documents medication administration prior to administering it Rationale: The charge nurse will intervene when the newly licensed nurse documents medication administration prior to administering it. Document the medication after administration, not before. Read medication labels and compare them with the MAR three times. Use bar code scanner to identify clients. Check a drug reference to ensure the dose is within the usual range.

A nurse is assessing a client prior to the administration of morphine. The nurse should recognize that which of the following assessments is the priority? a. Pupil reaction b. Urine output c. Bowel sounds d. Respiratory rate

d. Respiratory rate Rationale: The nurse assess the client's respiratory rate prior to the administration of morphine since morphine produces respiratory depression. Pupil reaction should be assessed, but it is not the priority. Urine output and bowel sounds should be monitored during treatment.

a nurse is providing teaching for a client who has diabetes and a new prescription for insulin glargine. which of the following should the nurse provide regarding this type of insulin? a. insulin glargine has a duration of 3-6 hours b. insulin glargine has a duration of 6-10 hours c. insulin glargine has a duration of 16-24 hours d. insulin glargine has a duration of 18-24 hours

d. insulin glargine has a duration of 18-24 hours rationale: it is a long duration insulin. it is only dosed once daily

a hospice nurse is caring for a client who has terminal cancer and takes PO morphine for pain relief. the client reports that he had an increased dose of the morphine this week to obtain pain relief. which of the following scenarios should the nurse document as the explanation of the situation? a. the client has not been taking the medication properly b. the client is experiencing episodes of confusion c. the client has become addicted to the medication d. the client has developed a tolerance to the medication

d. the client has developed a tolerance to the medication