How should a nurse assess a 4-year-old child with abdominal pain?a. By asking the child to point to where it hurtsb. By auscultating the child's abdomen for bowel soundsc. By observing position and behavior while the child is movingd. By questioning the parents about their child's eating and bowel habits

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1. How should a nurse assess a 4-year-old child with abdominal pain?

a. By asking the child to point to where it hurts

b. By auscultating the child's abdomen for bowel sounds

c. By observing position and behavior while the child is moving

d. By questioning the parents about their child's eating and bowel habits

A!

Arranging for the nurse manager to be present before confronting the staff nurse is a serious allegation, and confrontation should occur in the presence of a person in a supervisory position. Asking other staff members whether they have noticed anything unusual is unprofessional. The nurse in charge has enough information to confront the other nurse. Telling the staff nurse that everyone now knows who has been stealing the morphine may result in an altercation; a witness should be present. Arranging to secretly observe the staff nurse the next time the staff nurse administers morphine is unprofessional; the nurse in charge has a legal responsibility to intervene.
C!

Weight reduction decreases intraabdominal pressure, thereby decreasing the tendency to reflux into the esophagus. Fats decrease emptying of the stomach, extending the period that reflux can occur; fats should be decreased. Lying down after eating increases the pressure against the diaphragmatic hernia, increasing symptoms. Drinking several glasses of fluid during each meal will increase the pressure; fluid should be discouraged with meals.
D!

Many over-the-counter cold preparations contain acetaminophen; the amount of acetaminophen in cold preparations must be taken into consideration when the total amount of acetaminophen taken daily is calculated. A typical single dose is 650 mg a day for adults. Acetaminophen should not exceed 3 to 4 g a day, with a lower dose preferred in older adults. Taking oxycodone with the acetaminophen may result in an overdose. Oxycodone (Percocet) contains 325 to 650 mg of acetaminophen per dose, which should be calculated into the total grams of acetaminophen permitted daily. An emetic is contraindicated because it may reduce the client's ability to tolerate oral acetylcysteine, the antidote for acetaminophen toxicity.
C!

The child with abdominal pain may assume the side-lying position with the knees flexed to the abdomen or self-splint when moving. A 4-year-old may be unable to identify the exact location of the pain; in addition, the pain may be generalized rather than localized. Auscultation may be included in the physical assessment, but it is not specific to the assessment of pain. Questioning the parents may be included when the nurse is taking the health history, but it is not specific to the current assessment of pain.

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