A nurse is assessing a school-age child who is receiving morphine. For which of the following adverse effects should the nurse monitor?

Morphine is a potent opioid analgesic frequently used to manage severe pain in school-age children, particularly in postoperative or trauma settings. It works by binding to mu-opioid receptors in the central nervous system to alter the perception of and response to pain. However, morphine also acts as a powerful depressant on the brainstem respiratory centers, making it essential for the nurse to perform continuous or frequent respiratory assessments to ensure the child’s safety during therapy. Rationale: A. Hypertension is not a typical adverse effect of morphine administration. In fact, opioids often cause the opposite effect, hypotension, due to the induction of peripheral vasodilation and the suppression of the sympathetic nervous system. A child in severe pain may have a high blood pressure initially, but the administration of morphine should ideally return the blood pressure to a normal range rather than causing it to increase further. B. Stevens-Johnson syndrome is a rare, life-threatening skin and mucous membrane reaction that is typically associated with certain medications like anticonvulsants, sulfonamides, or allopurinol. It is characterized by a painful red or purplish rash that spreads and blisters. Although any medication can theoretically cause an allergic reaction, morphine is not a known primary trigger for this specific dermatological emergency. C. Prolonged wound healing is more commonly associated with chronic corticosteroid use, poor nutritional status, or inadequate tissue perfusion. Uncontrolled pain can theoretically cause physiological stress that slows recovery, but morphine itself does not directly impair the cellular processes involved in tissue repair or collagen synthesis. The nurse’s primary concern with morphine is the immediate physiological depression of vital functions. D. Bradypnea, or an abnormally slow respiratory rate, is the most significant and dangerous adverse effect of morphine. Opioids decrease the sensitivity of the respiratory center to carbon dioxide, which can lead to respiratory depression. In a school-age child, the nurse must monitor the depth and rate of respirations closely, as severe bradypnea can lead to hypoxia and respiratory arrest. This is the priority assessment whenever an opioid is administered.