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.

Answer and Explanation

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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Correct Answer is A

Explanation

Flaring of the nares, or widening of the nostrils, is a sign of respiratory distress in infants. It indicates that the child is working harder to breathe. This finding should alert the practical nurse (PN) that the child with bronchiolitis is in acute respiratory distress.

A resting respiratory rate of 35 breaths/minute (B) is within the normal range for a 3-month-old infant. Bilateral bronchial breath sounds (C) and diaphragmatic respirations (D) are not specific signs of acute respiratory distress in infants.

A. Level of pain sensation. B. Maternal blood pressure (BP). C. Infusion pump and IV site. D. Variability of fetal heart rate.

Correct Answer is B

Explanation

The greatest priority for the practical nurse to monitor during the administration of epidural anesthesia is maternal blood pressure (BP). Epidural anesthesia can cause maternal hypotension due to vasodilation and decreased venous return, which can result in decreased fetal perfusion and oxygenation. Therefore, it is important for the practical nurse to monitor maternal BP frequently and promptly report any significant changes to the healthcare provider. Options A, C, and D are also important assessments, but they are not the priority in this scenario.

Therefore, options A, C, and D are not answers because they are not the priority assessment during the administration of epidural anesthesia.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A 3-month-old with bronchiolitis is brought to the clinic experiencing irritability and poor oral intake. Which finding should alert the practical nurse (PN) that the child is in acute respiratory distress?

Correct Answer is A

Explanation

Epidural anesthesia is initiated for a primigravida at 40 weeks gestation who is in active labor. Which assessment has the greatest priority for the practical nurse to monitor during the administration of epidural anesthesia?

Correct Answer is B

Explanation

A newborn infant with a tracheoesophageal repair is receiving gastrostomy (GT) feedings postoperatively. Which intervention should the practical nurse (PN) implement during the GT feedings?

Following a hysterectomy, an older adult's complete metabolic panel findings indicate that her magnesium level is low. To help increase the client's magnesium level, the PN should suggest that the client increase her intake of which food?

The practical nurse (PN) notes several nutritional goals in a standardized plan of care used in the antepartum clinic. Which client goal takes priority?

The practical nurse (PN) is caring for a newborn whose mother has poorly controlled type 1 diabetes mellitus and observes the newborn is grunting with mild sternal retractions. The PN should recognize the newborn is exhibiting signs of which condition?

An older female client is admited to the orthopedic unit following surgical repair of a fractured hip. On the second postoperative day, the client becomes confused and repeatedly asks the practical nurse (PN) where she is. Which information should the PN obtain before reporting to the charge nurse?

The practical nurse (PN) is monitoring a 5-year-old following a fracture of the ulna. For which situation should the PN seek immediate intervention by the registered nurse (RN)?

During a well-baby clinic visit, a mother tells the practical nurse (PN) that her 12-month-old infant is not yet eating solid foods and drinks whole milk from a bottle. Based on these assessment findings, this infant is at the greatest risk for developing which condition?

The practical nurse (PN) is caring for an adolescent with type 1 diabetes mellitus who presents with an HbA1c of 11% (97 mmol/mol), thirst, and blurred vision. Which action should the PN take first?