A nurse is teaching the parent of a 3-year-old client about child development. Which of the following developmental tasks should the nurse include as the child's expected cognitive developmental stage?

Rationale:
A. Morphine typically causes miosis (constricted pupils), not dilation. A pupil diameter of 6 mm (dilated pupils) is not an expected therapeutic effect, but it is not the most immediately life-threatening finding in this scenario compared with severe hypotension.

B. This equates to about 30 mL/hr, which is borderline low but still may be acceptable depending on the client’s weight, hydration status, and clinical context. Morphine can also cause urinary retention, so this finding should be monitored but is not the priority.

C. Constipation is a very common adverse effect of morphine due to decreased gastrointestinal motility. While important to address with stool softeners or laxatives, it is not an acute emergency.

D. This is the priority finding because it indicates severe hypotension, which can lead to decreased tissue perfusion, shock, and organ failure. Morphine can cause vasodilation and histamine release, contributing to hypotension, especially when given IV. This requires immediate intervention and provider notification first, as it is life-threatening.

Rationale:
A. The nurse should not administer another dose of ibuprofen without first completing a proper pain assessment and verifying that it is safe based on dosing intervals and provider orders. Ibuprofen dosing is typically scheduled at specific intervals, and giving an additional dose without assessment may lead to overdose or adverse effects such as gastrointestinal bleeding or renal impairment.

B. The first action should always be to reassess the client’s pain using a standardized pain scale. Pain is subjective, and the nurse must gather objective data about severity, quality, and response to previous interventions before determining the next step. This assessment guides appropriate and safe intervention.

C. While the provider may need to be notified if pain is uncontrolled, the nurse must first assess the pain level and characteristics. Without reassessment, the nurse does not have sufficient data to communicate effectively or advocate for changes in the treatment plan.

D. Escalation to opioid therapy may be appropriate if pain is severe and unrelieved, but this decision must be based on a full assessment. Jumping directly to requesting opioids without reassessing violates the nursing process and may lead to inappropriate prescribing.