Question

The nurse assesses vital signs for multiple clients. Which assessment and client condition will cause the nurse the most concern?

A. The postoperative client medicated 3 hours prior for pain with a blood pressure of 194/88 mm Hg.

B. The older adult client diagnosed with bacterial pneumonia with a temperature of 100.8��F (38.2��C).

C. The adult client receiving patient controlled administration of morphine who has a respiratory rate of 9 breaths/minute.

D. The adult client admitted through the ED following a car accident with a pulse rate of 92 beats/minute.

Answer 1

The most concerning condition is the adult client on morphine with a respiratory rate of 9 breaths/minute, as it indicates potential opioid-induced respiratory depression.

Step-by-step explanation:

The assessment and client condition that will cause the most concern for the nurse is C. The adult client receiving patient controlled administration of morphine has a respiratory rate of 9 breaths/minute. A normal respiratory rate for adults is typically 12-18 breaths per minute. A rate of 9 breaths per minute is below the normal range and can be indicative of respiratory depression, which is a potentially life-threatening side effect of opioids like morphine. Immediate intervention is required to ensure the patient's safety and to address the cause of the decreased respiratory rate.