A six-year-old complains of pain at the surgical site, one hour after the nurse gave IV morphine, which is ordered every four hours prn pain. What is the nurse's best next step?

Ask the patient to wait a little longer for the medicine to work.

Review whether the morphine dose is therapeutic for his weight.

Call the physician immediately.

Encourage the child to use television as a form of distraction.

Answer and Explanation

The Correct Answer is C

A. Ask the patient to wait a little longer for the medicine to work.
This option may not be appropriate, especially if the child is experiencing significant pain. It's essential to address the child's pain promptly rather than asking them to wait, as adequate pain management is crucial for the child's well-being.
B. Review whether the morphine dose is therapeutic for his weight.
While reviewing the dose for the child's weight is important, it may not be the immediate next step in this situation. If the child is experiencing pain that persists after one hour, the priority is to address the immediate pain concern. The nurse can later review the medication orders and dosages in collaboration with the healthcare provider.
C. Call the physician immediately.
This is the most appropriate next step in this scenario. If the child is experiencing pain despite having received morphine one hour ago, contacting the physician is important to discuss the current situation, assess the need for additional pain management, and potentially make adjustments to the treatment plan.
D. Encourage the child to use television as a form of distraction.
Distraction can be a helpful complementary measure for managing pain, but it may not be sufficient in this case if the pain persists. The primary focus should be on addressing the pain through appropriate medical interventions, and calling the physician is a more urgent step.

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Correct Answer is C

Explanation

A. "You should always hold your child's hand when crossing the street."

This is a critical teaching point. Holding a child's hand while crossing the street is an important safety measure to prevent accidents and ensure the child's safety.

B. "Swim lessons would be important now to ensure your child is safe around a pool."

This is also a critical teaching point. Swim lessons can be essential for water safety, especially if there is a pool in the vicinity.

C. "Medications with childproof tops are safe to keep on the counter so you remember to take them."

This statement is incorrect. Medications, even with childproof tops, should be stored out of reach of children to prevent accidental ingestion. It's important to emphasize proper medication storage.

D. "All small objects should be kept out of your child's view since he may aspirate them."

This is a valid teaching point. Small objects can pose a choking hazard, and keeping them out of a child's reach is crucial for safety.

Correct Answer is ["3"]

Explanation

The FLACC (Face, Legs, Activity, Cry, Consolability) scale is commonly used to assess pain in preverbal children. Each category is scored on a scale from 0 to 2, and the total scores range from 0 to 10. Let's assess the given observations:

Face: occasional grimace (score 1)

Leg: relaxed (score 0)

Activity: squirming, tense (score 2)

Cry: no cry (score 0)

Consolability: content, relaxed (score 0)

Now add the scores together: 1 (Face) + 0 (Leg) + 2 (Activity) + 0 (Cry) + 0 (Consolability) = 3

Therefore, the FLACC score for this preverbal child is 3. This score indicates a moderate level of pain.

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A six-year-old complains of pain at the surgical site, one hour after the nurse gave IV morphine, which is ordered every four hours prn pain. What is the nurse's best next step?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is discussing safety with the father of a four-year old child. Critical teaching points should include the following except:

Correct Answer is C

Explanation

The nurse is using the FLACC scale to evaluate pain in a preverbal child. The nurse makes the following assessment: Face:occasional grimace; Leg: relaxed; Activity: squirming, tense; Cry: no cry; Consolability: content, relaxed. The nurse records patient's pain using the FLACC assessment as:

Correct Answer is ["3"]

Explanation

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