The nurse is using a postoperative pain management scale to determine if a newborn recovering from emergency surgery is experiencing pain. Which observations indicate that the child is experiencing level 3 pain this time? (Select all that apply.)
A) High-pitched cry
B) Baby is grimacing
C) Baby has not fallen asleep
D) Heart rate elevated to greater than 20% over the baseline
E) Baby falls asleep for short periods and then wakes up crying
A, C, D
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Observations that the infant is experiencing pain at a level 3 include a high-pitched cry, not sleeping, and a heart rate elevated to greater than 20% over the baby's baseline. Grimacing and falling asleep for short periods indicate pain at a level 2.
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Most hormones used for drug therapy are taken from ________.
Fill in the blank(s) with the appropriate word(s).
The client prescribed clonazepam (Klonopin) asks the nurse why the medication dose needs to be adjusted. What is the best response by the nurse?
1. "Tolerance can begin to develop after only a few months of therapy, and seizures can recur unless doses are periodically adjusted." 2. "Your dose will be decreased every month until you begin to have seizures again." 3. "Your body stores this drug, and you will need a lower dose of the medication now." 4. "The physician will not need to adjust your medication dose."
A perinatal nurse receives reports from the nurse aide on four patients who all gave birth within the last 4 hours. Which patient should the nurse assess first?
A. Blood loss of 850 mL during cesarean birth B. Exhausted mother wanting only to rest after childbirth C. Pulse consistently ranges from 82 to 90 beats/minute D. Systolic blood pressure change from 132 to 110 mm Hg
A 20-year-old patient who had an open appendectomy this morning has just been admitted to the postsurgical unit from postanesthetic recovery. The patient has a persistent cough that is likely a result of airway irritation caused by intubation
The patient has asked the nurse for something the help with his cough and the nurse is planning to ask the patient's physician for an order for codeine. The use of codeine is contraindicated in this patient because A) the resulting GI upset will increase his chance of developing paralytic ileus. B) codeine will not resolve coughing that is the result of physical airway irritation . C) codeine cannot be administered less than 48 hours after general anesthetic. D) codeine will make it more difficult for him to maintain a patient airway because of his post-operative status.