A patient with congestive heart failure and pulmonary edema is ...

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A patient with congestive heart failure and pulmonary edema is experiencing chest pain. The patient has an order for morphine sulfate IV 4 mg every 5 to 30 minutes PRN until chest pain is relieved.
 
  The last dose of 4 mg was 15 minutes prior, and the patient is complaining of chest pain and exhibiting increased work of breathing. The nurse notes a heart rate of 82 beats per minute, a respiratory rate of 18 breaths per minute, and a blood pressure of 135/88 mm Hg. What will the nurse do next?
  a. Administer morphine sulfate IV 4 mg over 1 to 5 minutes.
  b. Administer naloxone (Narcan) to reverse respiratory depression.
  c. Request an order for morphine sulfate IV 2 mg over 1 to 5 minutes.
  d. Hold the next dose and notify the provider of the patient's symptoms.

Question 2

A patient is brought to the emergency department after coming in contact with organophosphate insecticides while at work. The nurse will expect to administer which medication to reverse the toxic effects of this substance?
 
  a. Atropine sulfate
  b. Diazepam
  c. Epinephrine
  d. Flumazenil

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Answer to Question 1

ANS: A
Morphine acts to relieve pain, dilate venous vessels, and decrease the workload on the heart to treat acute cardiogenic pulmonary edema and can relieve the dyspnea caused by this condition. The nurse should administer 4 mg since the patient's pain has not abated. Respiratory depression would be characterized by a decreased respiratory rate.

Answer to Question 2

ANS: A
Atropine is used to counter the toxic effects of organophosphate insecticides. Diazepam is given for seizures and for acute alcohol withdrawal. Epinephrine is used for anaphylactic shock. Flumazenil is given as an antidote for benzodiazepine overdose.

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