A nurse is assessing a school-age child who is receiving morphine. For which of the following adverse effects should the nurse monitor?
Stevens-Johnson syndrome
Hypertension
Prolonged wound healing
Bradypnea
The Correct Answer is D
A. Stevens-Johnson syndrome is a severe, rare, and potentially life-threatening reaction that can occur as a hypersensitivity reaction to certain medications. However, it is not typically associated with morphine use.
B. Morphine is more commonly associated with hypotension rather than hypertension. Therefore, while monitoring for changes in blood pressure is important, hypertension is not a primary concern with morphine administration.
C. Morphine use is not typically associated with prolonged wound healing. However, it can cause respiratory depression, which can indirectly affect wound healing by reducing tissue oxygenation.
D. Morphine is a potent opioid analgesic that can cause respiratory depression, leading to bradypnea (slow breathing) or even respiratory arrest. Monitoring respiratory rate is crucial when administering morphine to detect signs of respiratory depression early and intervene promptly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Visual analog scales rely on the child's ability to comprehend and interpret visual cues, which may be challenging for a cognitively impaired toddler.
B. FACES scales require the child to identify their pain level based on facial expressions, which may also be challenging for a cognitively impaired toddler.
C. FLACC (Face, Legs, Activity, Cry, Consolability) scales are specifically designed for non-verbal or cognitively impaired individuals, assessing pain based on observable behaviors such as facial expression, leg movement, activity level, cry, and ability to be consoled.
D. CRIES scales are primarily used for assessing pain in newborns and infants and may not be as applicable for a cognitively impaired toddler.
Correct Answer is A
Explanation
A) Oral electrolyte solution helps prevent dehydration and replaces lost electrolytes in infants with acute diarrhea, making it the most appropriate choice.
B) Applesauce may worsen diarrhea due to its high sugar content.
C) White grape juice is also high in sugar and may worsen diarrhea.
D) Chicken soup is not recommended as it may be too heavy and rich for an infant with acute diarrhea.
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