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NCLEX Question of the Day
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A nurse is reviewing new prescriptions for a client admitted with pneumonia. One prescription reads: "Morphine sulfate 2.5 mg IV push every 4 hours PRN for severe pain." The hospital pharmacy stocks morphine sulfate in 4 mg/mL vials. Which action by the nurse demonstrates safe medication administration?
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Ask the healthcare provider to change the order to 4 mg IV push every 4 hours.
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Correct answer Consult with the pharmacist to obtain a pre-filled syringe or a lower concentration vial.
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Draw up 1 mL, waste 0.37 mL with another licensed nurse, and administer 0.63 mL.
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Draw up 0.63 mL in a 1 mL syringe and administer as ordered.
Rationale
Administering potent medications like opioids requires extreme caution to prevent dosing errors. Measuring a precise dose like 2.5 mg from a 4 mg/mL vial (requires drawing 0.625 mL, often rounded to 0.63 mL) using a standard syringe can be difficult and increases the risk of error, especially with high-alert medications. Consulting the pharmacist to obtain the medication in a more readily administrable form (like a pre-filled syringe or a lower concentration, e.g., 2 mg/mL) is the safest approach, minimizing the potential for calculation or measurement errors.
While calculating 0.63 mL is mathematically correct, the potential for error in drawing up such a small, specific volume of a high-alert drug makes this less safe than obtaining a pre-filled or lower-concentration option. Wasting medication requires a witness but doesn't eliminate the risk associated with drawing up the initial small, precise dose. Asking the provider to change the order based on available stock concentration, rather than the client's assessed need, is inappropriate and potentially unsafe if 4 mg is too high a dose for the client.
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