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    Hesi lpn exit proctored examQuestion 203
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    Hesi lpn exit proctored exam

    The practical nurse (PN) is caring for a 3-month-old client two days after a pylorotomy and notices that the infant is restless, grimacing, and drawing his knees to his chest. Which action should the PN implement?

    Explanation & Rationale

    A. Give prescribed analgesic: The infant’s signs indicate pain likely related to the recent pylorotomy. Administering the prescribed analgesic addresses the primary problem, reduces discomfort, and promotes healing and recovery. B. Wrap child with a warm blanket: While wrapping the infant may provide comfort and a sense of security, it does not directly relieve pain from a surgical procedure. Pain management requires pharmacologic intervention in addition to comfort measures. C. Burp the infant every two hours: Burping helps reduce gastrointestinal discomfort from trapped air but is not sufficient to address surgical pain. The infant’s symptoms suggest more significant discomfort than routine burping can relieve. D. Obtain blood glucose level: Checking glucose is not immediately indicated unless there is suspicion of hypoglycemia. The clinical presentation here is more consistent with postoperative pain rather than metabolic imbalance.

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