A 10-year-old has been receiving morphine every 2 hours for ...

[cookcarl]

A 10-year-old has been receiving morphine every 2 hours for postoperative pain as ordered. The medication relieves the pain for approximately 90 minutes and then the pain returns. The nurse should:
 
  1. Tell the child that pain medication cannot be administered more frequently than every 2 hours.
  2. Reposition the child and quietly leave the room.
  3. Inform the parents that the child is dependent on the medication.
  4. Call the physician to see if the child's orders for pain medication can be changed.

Question 2

Before the nurse begins to dry the newborn off after birth, which of the following assessment findings should the nurse document to ensure an accurate gestational rating on the Ballard gestational assessment tool?
 
  1. Amount and area of vernix coverage
  2. Creases on the sole
  3. Size of the areola
  4. Body surface temperature

[jackie]

Answer to Question 1

4
Rationale:
1. The nurse has the responsibility to relieve the child's pain. The physician should be called to see if the child's orders can be changed.
2. Repositioning the child is not an appropriate method to relieve pain in this case. The nurse has the responsibility to relieve the child's pain. The physician should be called to see if the child's orders can be changed.
3. The child is entitled to pain relief medication; the child is not dependent on the medication. The nurse has the responsibility to relieve the child's pain. The physician should be called to see if the child's orders can be changed.
4. The nurse has the responsibility to relieve the child's pain. The physician should be called to see if the child's orders can be changed.

Answer to Question 2

1
Rationale:
1. Drying the baby after birth will disturb the vernix and potentially alter the score when using the Ballard gestational assessment tool. The nurse first should document the amount and coverage of the vernix before drying the newborn.
2. Creases on the sole are not affected by drying of the newborn.
3. Size of the areola is not affected by drying of the newborn.
4. Body surface temperature is not part of the Ballard gestational assessment tool.

[cookcarl]

Gracias!

[bdobbins]

Excellent