The laboring patient has rated her pain at 9 on a scale of 1–10, and requests IV pain medication. Which statement is most important for the nurse to make? "Narcotic medications:
1. "Can make you unsteady. You need to ask for help when you get up."
2. "Have a very rapid onset and begin to work in 2–3 minutes."
3. "Are metabolized by your body, so they don't last as long as an epidural."
4. "Can cause sleepiness in the baby that can be reversed with Narcan."
1
Rationale 1: Being unsteady when getting up is a common side effect of narcotic medications, and a safety issue. To prevent falls, it is important that patients receiving IV narcotics ask for assistance when they are getting up.
Rationale 2: This is true, but is not the most important consideration.
Rationale 3: This is true, but is not the most important consideration.
Rationale 4: The patient might not know that respiratory depression can occur, or understand what "reversal" is. This is technical information that the patient has not asked for.
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The nurse carefully measures drainage during the first 24 hours after surgery on a patient with a Jackson-Pratt drain. It is considered abnormal if the drainage exceeds:
a. 50 mL. b. 100 mL. c. 200 mL. d. 300 mL.
Newborns whose mothers are substance abusers frequently have which behaviors?
a. Hypothermia, decreased muscle tone, and weak sucking reflex b. Excessive sleep, weak cry, and diminished grasp reflex c. Circumoral cyanosis, hyperactive Babinski reflex, and constipation d. Decreased amounts of sleep, hyperactive Moro reflex, and difficulty feeding
The nurse is caring for a newborn 30 minutes after birth. After assessing respiratory function, the nurse would report which findings as abnormal? Note: Credit will be given only if all correct and no incorrect choices are selected
Select all that apply. 1. Respiratory rate of 66 breaths per minute 2. Periodic breathing with pauses of 25 seconds 3. Synchronous chest and abdomen movements 4. Grunting on expiration 5. Nasal flaring
The ANA, which is committed to monitoring the regulation, education, and use of NAPs, recommends adherence to which one of the following principles?
A) It is the nursing profession that determines the scope of nursing practice. B) It is the RN who defines and supervises the education, training, and use of any unlicensed assistant roles. C) It is the assigned NAP who is responsible and accountable for his or her nursing practice. D) It is the purpose of the RN to work in a supportive role to the assistive personnel.