Exhibits

The nurse is reviewing the prescription and planning the appropriate pain management.

Complete the following sentence by choosing from the lists of options.

For best pain management, the nurse should give... of acetaminophen every 4 hours as scheduled.

3.3 mL

1.9 mL

5.0 mL

0.8 mL

Answer and Explanation

The Correct Answer is A

A. 3.3mL: The correct dose for infants is 10–15 mg/kg every 4–6 hours. If the infant weighs 7 kg, the correct dose is:Minimum dose: 10 mg × 7 kg = 70 mg. Maximum dose: 15 mg × 7 kg = 105 mg. Since the standard concentration is 160 mg/5 mL, the correct volume for 105 mg is 3.3 mL, making it the most appropriate dose.
B. 1.9 mL: This provides only about 61 mg of acetaminophen, which is below the recommended 10 mg/kg minimum dose, making it potentially ineffective.
C. 5.0 mL: This equates to 160 mg of acetaminophen, which exceeds the safe dose range for most infants, increasing the risk of liver toxicity.
D. 0.8 mL: This would provide only about 26 mg of acetaminophen, which is severely underdosed and unlikely to provide adequate pain relief.

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Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

Mastitis: Mastitis is an infection of breast tissue that occurs when milk stasis leads to bacterial overgrowth, usually caused by Staphylococcus aureus. The client's firm, red, warm area on the breast, fever (101.2°F), chills, body aches, and fatigue all strongly indicate mastitis rather than other breast conditions.
Engorgement: Engorgement occurs when the breasts overfill with milk, leading to swelling and tenderness. However, engorgement typically affects both breasts, does not cause fever or flu-like symptoms, and resolves with regular breastfeeding or pumping.
Blocked milk duct: A clogged duct occurs when milk flow is obstructed, leading to a tender lump in the breast. While a blocked duct can progress to mastitis, it does not cause fever or systemic symptoms unless infection develops. The presence of fever and flu-like symptoms in this client suggests mastitis, not just a blocked duct.
Inflammatory breast cancer: This rare but aggressive form of breast cancer causes redness, swelling, and skin thickening, but it is not associated with fever or acute symptoms like mastitis. It does not develop suddenly but rather progresses over time, making mastitis the more likely diagnosis in this case.
Abscess: If mastitis is not treated promptly, it can lead to a breast abscess, a localized collection of pus requiring drainage. Signs of progression to an abscess include fluctuant swelling, worsening pain, and persistent fever despite antibiotic treatment.
Breastfeeding intolerance: Mastitis can cause temporary discomfort during breastfeeding, but it does not lead to true breastfeeding intolerance. In fact, continued breastfeeding helps resolve mastitis by improving milk drainage.
Nipple thrush: Nipple thrush (Candida infection) causes burning pain and white patches in the infant’s mouth but is not a complication of mastitis, which is bacterial, not fungal.
Postpartum haemorrhage: Postpartum hemorrhage is caused by uterine atony, retained placenta, or coagulation disorders, not mastitis. Mastitis is localized to the breast and does not affect uterine bleeding.

A. Blood type B. Parents religious affiliation C. Blood pressure D. Level of consciousness E. Hearing acuity F. Heart rate G. Deep tendon reflexes

Correct Answer is ["A","D","F"]

Explanation

A. Blood type: While important for transfusions, blood type is not relevant to assessing pain or determining appropriate pain management strategies. Pain assessment focuses on physiological and behavioral cues, not blood compatibility.
B. Parents’ religious affiliation: Religious beliefs may influence pain management preferences (e.g., preference for non-pharmacologic methods), but this is not a priority assessment before implementing pain management strategies. The immediate focus should be on assessing the infant’s pain level and physiological status.
C. Blood pressure: Pain can cause increased sympathetic nervous system activity, leading to elevated blood pressure. Monitoring blood pressure helps assess the severity of pain and guides appropriate pain management interventions.
D. Level of consciousness: Infants in significant pain may become restless, irritable, or inconsolable, while excessive sedation from pain medications can cause decreased responsiveness. Assessing level of consciousness helps ensure that pain relief measures do not cause over-sedation or respiratory depression.
E. Hearing acuity: Hearing assessment is not relevant for pain management in a 4-month-old infant. Pain assessment in infants focuses on physiological signs, crying, and behavioral responses, rather than auditory abilities.
F. Heart rate: Pain can lead to tachycardia due to sympathetic nervous system activation. Monitoring heart rate helps assess pain intensity and evaluate the effectiveness of pain relief interventions.
G. Deep tendon reflexes: Reflex testing is used for neurological assessment but is not relevant to pain management. Reflexes do not provide direct information about pain intensity or response to treatment.

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Exhibits The nurse is reviewing the prescription and planning the appropriate pain management. Complete the following sentence by choosing from the lists of options. For best pain management, the nurse should give... of acetaminophen every 4 hours as scheduled.

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Naxlex Comprehensive Predictor Exams

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

Exhibits Which other assessment data would the nurse want to collect before implementing pain management strategies? Select all that apply.

Correct Answer is ["A","D","F"]

Explanation

A 34-week gestation multigravida comes to the clinic for her bimonthly appointment. Which assessment finding should the nurse report to the healthcare provider (HCP)?

Exhibits The nurse determines the client is in pain. Which pain scales would be appropriate for this client? Select all that apply.

A client who is 37 weeks gestation comes to the women's health clinic reporting an excruciating headache. On examination, the nurse determines the client has an elevated blood pressure. Which action should the nurse implement next?

During the admission procedure of a school age child, the child states, "I'm going to have an operation." Which response is best for the nurse to provide to this child?

Exhibits The nurse reviews the client's history and physical, the nurses' notes, and the flow sheet. Select the findings that will help the nurse determine what is causing the client's symptoms.

Which is the most important assessment for the nurse to conduct following the administration of epidural anesthesia to a client who is at 40-weeks gestation?

The nurse is caring for an infant admitted with dehydration, irritability, signs of extreme hunger, and a palpable olive-like mass in the upper right abdominal quadrant. When feeding the infant, the nurse should monitor for which development?

Exhibits Which description(s) by the client should help confirm that the mastitis has been resolved and breastfeeding/breast health is well maintained? Select all that apply.

Exhibits

The nurse is reviewing the prescription and planning the appropriate pain management.

Complete the following sentence by choosing from the lists of options.

For best pain management, the nurse should give... of acetaminophen every 4 hours as scheduled.