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Mrs. P. is an 83-year-old woman who has been having upper abdominal pains that wake her up at night for the past 2 weeks. In addition to upper abdominal pains, Mrs. P. has been feeling nauseated, fatigued, and weak and has a feeling of being full quickly when eating, accompanied by heartburn. She also has been using over-the-counter Tums (calcium carbonate) without relief of her complaints. After several nights of losing sleep, her husband decides to take her to the emergency department (ED).

In the ED, Mrs. P. has blood drawn, gives a urine sample, has an electrocardiogram done, and has an intravenous (IV) line started. Her past medical history includes osteoarthritis, hypertension, elevated cholesterol, and hypothyroidism. She takes ibuprofen 800 mg as needed for joint pains, amlodipine (Norvasc) every day for blood pressure (BP), atorvastatin (Lipitor) for her cholesterol, and levothyroxine (Synthroid) for her thyroid. She takes ibuprofen three times a day, according to her husband. Her vital signs in the ED are BP, 118/60 mm Hg; heart rate (HR), 90 beats/min; respiratory rate, (RR) 22 breaths/min; and an oral temperature of 98.6°F.

After a few hours, her blood work shows a decreased hematocrit and hemoglobin, and the ED physician decides to send Mrs. P. to the endoscopy unit for an esophagogastroduodenoscopy (EGD). In the endoscopy laboratory, she receives the following medications:

Midazolam (Versed) 3 mg IV

Fentanyl 100 mcg IV

Question1

After giving this medication, you know to monitor Mrs. P. for which adverse effects of midazolam? (Select all that apply.)

a)Hypotension

b)Respiratory depression

c)Fever

d)Tachycardia

e)Confusion

f)Nausea and Vomiting

Question2

As the nurse, you know that administering fentanyl to Mrs. P. will produce which effects? (Select all that apply.)

a)Analgesia

b)Fever reduction

c)Bradycardia

d)Production of clay-colored stools

e)Reduction in gastric acid secretion