Question

A patient is admitted to the coronary care unit following a cardiac arrest and successful cardiopulmonary resuscitation (actually causes a lot of bruising and collateral damage). When reviewing the health care provider's admission orders, which of the following orders is it most important for the nurse to question?

A. Oxygen at 4 L/min per nasal cannula
B. Morphine sulfate 2 mg IV every 10 minutes until the pain is relieved
C. Tissue plasminogen activator (t-PA) 100 mg IV infused over 3 hours
D. IV nitroglycerin at 5 mcg/minute and increase 5 mcg/minute every 3 to 5 minutes

Answer 1

The nurse should question the order for Morphine sulfate 2 mg IV every 10 minutes until the pain is relieved, as this could cause respiratory depression or hypotension without frequent pain assessments post-cardiac arrest.

Step-by-step explanation:

The order to most importantly question is B. Morphine sulfate 2 mg IV every 10 minutes until the pain is relieved. Post-cardiac arrest, it is crucial to control pain; however, continuous doses in such a short period could lead to opioid overdose, causing respiratory depression or hypotension, especially when the patient's pain level isn't regularly assessed. Both options A (Oxygen at 4 L/min per nasal cannula) and D (IV nitroglycerin at 5 mcg/minute) are standard post-cardiac arrest treatments to assist with oxygenation and relieve chest pain. Option C, administering tissue plasminogen activator (t-PA), is utilized for its clot dissolving properties and is suitable unless a hemorrhagic event is suspected. The nurse should verify all orders are appropriate for the patient's condition but should be particularly cautious with the morphine dosing regimen.