Prior to administering pain medication to an adult postoperative client, what information should the practical nurse (PN) obtain? (Select all that apply.)

Height and weight of client prior to admission

Client's pain rating on a scale of 1 to 10

Time of last administration of pain medication

Eﬀectiveness of last pain medication administered

History of pain medication use during the past year

Answer and Explanation

Correct Answer : B,C,D

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Correct Answer is C

Explanation

Choice A rationale:

Tape the tube to the child's cheek. Rationale: Taping the tube to the child's cheek is not the recommended method for securing a gastrostomy enteral tube. It can cause discomfort and skin irritation for the child. Proper securing methods involve using specialized tube holders or dressings designed for this purpose.

Choice B rationale:

Apply water-soluble lubricant to the site. Rationale: Applying a water-soluble lubricant to the site is not a standard practice for gastrostomy tube care. It is essential to keep the site clean and dry to prevent infection. Lubricants are not typically used in this context.

Choice C rationale:

Attach an extension tube to the site's opening prior to use. Rationale: This is the correct action. Before using the gastrostomy tube, it is essential to attach an extension tube to the site's opening to facilitate feeding or medication administration. This extension tube allows for the connection of feeding syringes or other equipment.

Choice D rationale:

Apply a skin barrier protectant to the site. Rationale: Applying a skin barrier protectant is not typically required for gastrostomy tube care. The primary focus should be on maintaining the cleanliness and integrity of the site to prevent complications such as infection or skin irritation.

A. "You should place the diaper over the strap of the harness.” B. "The harness can be removed for sleeping each night.” C. "You can apply lotion under the straps of the harness.” D. "The harness can promote hip joint development.”

Correct Answer is D

Explanation

Choice A rationale:

The nurse should not recommend placing the diaper over the strap of the Pavlik harness. Placing the diaper over the strap can cause discomfort and may interfere with the proper function of the harness, which is designed to maintain hip joint alignment in infants with developmental hip dysplasia.

Choice B rationale:

The Pavlik harness is typically worn continuously, including during sleep. It should not be removed for sleeping each night because consistent use is essential for its effectiveness in promoting hip joint development.

Choice C rationale:

Applying lotion under the straps of the harness is not recommended. Lotions or creams can create friction and moisture, which may lead to skin irritation or discomfort for the infant. It's best to follow the healthcare provider's instructions regarding the care and maintenance of the harness.

Choice D rationale:

The correct choice is D. The nurse should include the statement that "The harness can promote hip joint development" in the teaching. This is because the Pavlik harness is used to treat developmental hip dysplasia by maintaining the hip joint in a stable position, allowing for proper development. It is important for parents to understand the purpose and benefits of the harness in order to ensure compliance and effectiveness of the treatment.

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Prior to administering pain medication to an adult postoperative client, what information should the practical nurse (PN) obtain? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing site care for a child who has a gastrostomy enteral tube.Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is reinforcing teaching with the parents of an infant who has a Pavlik harness. Which of the following statements should the nurse include in the teaching?

Correct Answer is D

Explanation

A nurse begins to bathe a newly admitted client who reports that they have not had anything to eat that day. The nurse interrupts the bath and obtains a healthy meal for the client. This action by the nurse is an example of which of the following?

A nurse is reinforcing teaching with a client who has an open leg wound and is experiencing difficulty healing.The nurse should encourage the client to increase which of the following nutrients in his diet?

A nurse in a provider's office is caring for a group of clients who have communicable diseases.Which of the following infections should the nurse report to the state health department?

A nurse in a provider's office is collecting data from a client who has psoriasis. Which of the following statements by the client should the nurse report to the provider?

A nurse is caring for an older adult client who wears hearing aids with detachable ear molds.Which of the following actions should the nurse take when caring for the hearing aids?

A nurse is reinforcing teaching with a new mother about facility security measures.Which of the following statements by the mother indicates an understanding of the teaching?

A nurse is assisting a client who has cancer to select high-protein foods. Which of the following foods should the nurse recommend as the highest source of protein?

A nurse is monitoring an assistive personnel (AP) who is applying elastic antiembolic stockings for a client who has phlebitis. Which of the following actions by the AP indicates that they are performing the skill correctly?