A nurse is collecting data from a client who is receiving hydromorphone for pain management. For which of the following findings should the nurse notify the provider?
Explanation & Rationale
A. Blood pressure 108/68 mm Hg: This blood pressure is slightly lower than average but generally within a safe range. Hydromorphone can cause hypotension, but this reading alone does not necessitate immediate intervention. B. Respiratory rate 14/min: A respiratory rate of 14 breaths per minute is within the normal adult range (12–20/min), indicating that the client is not experiencing significant opioid-induced respiratory depression. C. Urinary output 160 mL/8 hr: A urinary output of 160 mL over 8 hours is significantly below normal (expected >30 mL/hr). Oliguria can indicate opioid-induced urinary retention or other complications. The nurse should notify the provider for assessment and possible intervention. D. Oxygen saturation 95%: An oxygen saturation of 95% is within normal limits for most adults and does not indicate hypoxemia. Continued monitoring is appropriate, but immediate notification is not required.