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Difficulty: MediumPharmacological and Parenteral Therapies

During a routine assessment, a postoperative client reports sudden and severe surgical site pain, rating it a 9 on a 0-to-10 scale. The client currently has an active transfusion of packed red blood cells (PRBCs) infusing through their only established peripheral intravenous (IV) catheter. The provider has prescribed an as-needed dose of intravenous morphine. Which action represents the safest method for the nurse to deliver this analgesic?

  1. Initiate a separate peripheral venous access site to deliver the medication.Answer
  2. B
    Inject the analgesic slowly into the Y-site port closest to the client on the blood tubing.
  3. C
    Temporarily halt the transfusion, flush the catheter with normal saline, administer the dose, and restart the blood.
  4. D
    Delay the administration of the analgesic until the packed red blood cells have completely infused.

Answer

Initiate a separate peripheral venous access site to deliver the medication.
The correct action is to initiate a separate peripheral venous access site. The absolute rule of blood transfusion therapy is that no medications may be added to blood products or infused through the same blood administration tubing. Because the client is experiencing severe pain, the medication is urgently needed and should not be delayed. Establishing a second IV line is the only way to deliver the medication promptly and safely.

Step-by-Step Solution

1
Assess the client's current IV access and the active infusions.
The client has a single IV line actively infusing packed red blood cells (PRBCs).
Identifying existing access points determines if the new medication can be safely administered or if new access is required.
2
Determine compatibility rules for the active infusion.
Blood products are strictly incompatible with all medications and all IV fluids except 0.9% sodium chloride.
Mixing medications with blood can cause fatal hemolysis or precipitation.
3
Evaluate the clinical priority of the prescribed medication.
The client has severe pain (9/10), making the administration of morphine a high priority that cannot wait until the transfusion concludes.
Timely pain management promotes healing and physiological stability.
4
Formulate a safe administration plan.
A new, dedicated peripheral IV line must be inserted.
This allows for the immediate, safe administration of the analgesic without compromising the blood transfusion.

Key Concept

Blood products must never be mixed with any medications. If a client requires an urgent IV medication during a transfusion and only has one line, a new IV access site must be established.
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Topics

Pharmacological and Parenteral Therapies

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