Exhibits

A nurse is caring for a child who is 2 hr postoperative. Which of the following actions should the nurse take first? (Click the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Assess the child's pain level.

Recheck the child's temperature.

Determine the child's sedation level.

Compare the child's pedal pulses.

Answer and Explanation

The Correct Answer is D

A. Assessing the child's pain level is important but may not be the first priority postoperatively, especially if there are signs of compromised circulation.

B. Rechecking the child's temperature is important but may not be the first priority postoperatively unless there are specific concerns related to temperature regulation.

C. Determining the child's sedation level is important for monitoring but may not be the first priority unless there are signs of respiratory compromise or other urgent concerns.

D. Comparing the child's pedal pulses is crucial in this situation as the child has undergone surgical procedures on the lower extremity, and changes in pedal pulses could indicate compromised circulation, which requires immediate attention to prevent complications such as compartment syndrome.

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Correct Answer is A

Explanation

A. Applying a topical anesthetic cream 1 hour prior to the procedure can help reduce pain and discomfort during venipuncture, ensuring atraumatic care for the child.

B. The procedure should not be performed in the playroom, as it may cause distress to the child and create a negative association with that space.

C. The presence of a parent during the procedure can provide comfort and support to the child, reducing anxiety and fear.

D. Explaining the procedure in detail 3 hours prior may cause unnecessary anxiety. A brief, simple explanation right before the procedure is more appropriate for a 4-year-old.

A. Bradypnea B. Stevens-Johnson syndrome C. Prolonged wound healing D. Hypertension

Correct Answer is A

Explanation

A. Bradypnea is a common adverse effect of morphine, especially in children, due to its respiratory depressant properties.

B. Stevens-Johnson syndrome is a rare and serious skin reaction typically associated with other medications, not morphine.

C. Prolonged wound healing is not a common adverse effect of morphine, though it can be a concern with long-term opioid use.

D. Hypertension is not a typical side effect of morphine, which generally causes hypotension due to its vasodilatory effects.

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Exhibits A nurse is caring for a child who is 2 hr postoperative. Which of the following actions should the nurse take first? (Click the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Exhibits

A nurse is caring for a child who is 2 hr postoperative. Which of the following actions should the nurse take first? (Click the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)