The practical nurse (PN) caring for a 3-month-old boy one day after a pyloromyotomy notices that the infant is restless, is exhibiting facial grimaces, and is drawing his knees to his chest. What action should the PN take?
Feed one ounce of formula to correct hypoglycemia.
Administer a prescribed analgesia for pain.
Provide additional blankets to increase body temperature.
Increase IV infusion rate for rehydration.
The Correct Answer is B
The infant's symptoms are consistent with postoperative pain, which can be expected following a surgical procedure like pyloromyotomy. The PN should administer the prescribed analgesic medication to relieve the infant's discomfort and pain. It is crucial to manage pain appropriately in infants to promote healing, improve feeding tolerance, and prevent complications.
Option A is not appropriate as the infant's symptoms are not indicative of hypoglycemia.
Option C is not appropriate as the infant's symptoms do not indicate hypothermia.
Option D is not appropriate as the infant's symptoms do not indicate dehydration.
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Related Questions
Correct Answer is C
Explanation
Limited abduction of the legs in a newborn can be a sign of developmental dysplasia of the hip (DDH), a condition in which the hip joint is not properly formed. The practical nurse (PN) should notify the healthcare provider of this finding so that further assessment and appropriate intervention can be initiated.
Performing range of motion to the joint (A) is not appropriate without a healthcare provider's order. Continuing care as if this is a normal finding (B) is not appropriate because limited abduction of the legs in a newborn can be a sign of DDH. While documenting the finding in the record (D) is important, notifying the healthcare provider is the most important action for the PN to take next.
Correct Answer is B
Explanation
Detoxification can be a difficult and potentially dangerous process, and it's important for the client to receive proper monitoring and medication management during this time. The hospital is equipped to provide this level of care and support. The practical nurse should explain this to the client and emphasize the importance of receiving proper care during detoxification.
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