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    Dosage Calculation Proctored Exam

    Which prescribed medication can the nurse instruct the client to crush if needed?

    Explanation & Rationale

    A) Metoprolol XL: Metoprolol XL (extended-release) should not be crushed. Crushing extended-release formulations can result in the rapid release of the drug, leading to an overdose or adverse effects due to the immediate release of the full dose. The nurse should advise the client to swallow this medication whole. B) Ibuprofen EC (enteric-coated): Enteric-coated medications should not be crushed. The enteric coating is designed to protect the stomach lining by preventing the medication from being released in the stomach. Crushing the tablet would destroy this protective mechanism and could irritate the stomach lining, leading to discomfort or ulceration. C) Morphine ER (extended-release): Extended-release formulations of morphine should never be crushed. Crushing extended-release formulations can lead to a potentially fatal overdose because it releases the entire dose of medication at once. This can cause respiratory depression and other life-threatening effects. D) Acetaminophen: Acetaminophen in its regular tablet form can be safely crushed if needed. Crushing acetaminophen does not affect its effectiveness or safety, and it is a non-extended-release formulation, making it safe for manipulation when necessary, such as for clients with difficulty swallowing. However, it's essential to verify with the specific prescription, as acetaminophen is also available in extended-release formulations, which should not be crushed.

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