Chapter 36 Peds PrepU

The mother of a child who just had abdominal surgery holds his hand and smooths his hair. When the nurse appears to administer a scheduled analgesic, the mother says she believes the child has been in pain the last hour or more. The nurse's best response is:

"Please tell me and all of the nurses when you believe he is in pain."

A parent expresses concern about a child who is reporting shoulder pain following abdominal laparoscopic appendectomy. What is the nurse's best response to this concern?

"This is referred pain and is normal after surgery."

The nurse is assessing the abdomen of a preschooler admitted for lower right quadrant pain. Which assessment questions provide helpful data? Select all that apply.

"Touch the spot on your tummy where it hurts." "Choose the face that shows how you feel now." (FACES pain rating scale)

A 4-year-old child is scheduled for an MRI. The child's parent is informed that the child will be free of pain but sedated to ensure stillness during the procedure. Which type of anesthesia does the nurse expect this child to have?

Conscious sedation

The nurse is caring for a 7-year-old postoperative child who is reporting an 8 out of 10 on a pain intensity scale. The child's parent is requesting pain medication. The child received ibuprofen 3 hours ago. What is the correct nursing action?

Contact the health care provider and request an opioid pain medication.

The nurse is providing postsurgical care for a 4-year-old boy following hernia repair. Before surgery, the nurse taught the child to use the poker chip tool to rate his pain. When assessing the child's postsurgical pain, the boy refuses to touch the chips and clings to his mother. How should the nurse respond?

Give the mother the FACES pain rating scale to use with her son.

A 5-year-old child has been admitted to the hospital and is going to have an IV started in the procedure room. Which instructions will be most helpful for the child and the parent?

Have the parent sing softly to the child during the procedure.

The pediatric nurse is mentoring a new graduate in the care of children experiencing pain. The nurse knows the teaching was effective when the new graduate makes which statement as the rationale for considering pain assessment?

Pain assessment needs to be done at regular intervals.

When caring for pediatric clients, which distraction technique is age-appropriate for the nurse to use?

Provide action-oriented video games to a 15-year-old client.

What behavioral responses to pain would a nurse observe from an infant younger than age 1?

Reflex withdrawal to stimulus and facial grimacing

The nurse is working with the mother of a 6-year-old girl to think of an effective means of distracting the girl from a painful procedure that she will shortly undergo. To be effective, the distraction technique must have which characteristics?

Requires concentration of the child

The emergency department nurse is reviewing the medical record of a recently admitted infant and notes that the child's pain score is 14. The nurse realizes that the infant was assessed using which pain scale?

Riley Infants Pain Scale

A nurse is caring for a 4-year-old child who is exhibiting extreme anxiety and behavioral upset prior to receiving stitches for a deep chin laceration. Which nursing intervention is a priority?

Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen.

A six-year-old child is observed sucking the thumb and baby talking while hospitalized for cellulitis. How would the nurse explain this to the parents?

The child may be in pain.

The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made?

The child's nonverbal behaviors may indicate the presence of discomfort.

A nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain?

decreased heart rate

The nurse is preparing to administer an IM injection to a 5-year-old and asks the student working with the child to assist by blowing bubbles for the client while the nurse gives the injection. Which type of pain management is blowing bubbles?

distraction

A nurse is caring for a child who is grimacing but reports having no pain. What might be the rationale for a child being reluctant to express pain?

fearing getting a "shot" to relieve the pain

An adolescent is experiencing severe pain due to a sickle cell crisis. Which medication would be best for the nurse to administer?

hydromorphone

The nurse is caring for a 6-year-old sickle-cell client in an acute care setting. A high priority for this client's plan of care is pain relief. The nurse understands that untreated acute pain can lead to which physiologic effects?

impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression

A nursery nurse is explaining to a new parent about how to assess the newborn for pain. Which manifestation indicates that an infant is in pain?

inability to be consoled

Which type of medication lacks a ceiling effect, and therefore is prescribed in initial doses that must be titrated to achieve pain relief while managing side effects?

morphine

A 10-year-old child is scheduled for open reduction and internal fixation of the tibia following a skateboard accident. The nurse anticipates which pain medication and administration method will best provide postsurgical pain relief for this child immediately after surgery?

morphine given as an intravenous injection

The nurse is caring for a child who has received postoperative epidural analgesia. Which nursing assessment is priority?

respiratory depression

The nurse is caring for a client receiving opioid medication for the treatment of postoperative pain. What are common side effects that the nurse should observe for?

respiratory depression, constipation, and pruritis

What are some negative effects that chronic pain can have on the pediatric population?

sleep disturbances, exhaustion, irritability, mood disturbances, and depression

A young child is in the emergency department with swelling and pain in the right ankle. The client states that while playing soccer, she somehow twisted her ankle and could not walk off the field. The health care provider tells the client that it is a sprain. Which type of pain is this client experiencing?

somatic

The nurse is caring for a 2-year-old postoperative PET client. Which consideration is the most appropriate for this child's developmental stage?

uses words for pain such as owie, boo-boo, or hurt

The nurse is caring for a client who has been diagnosed with a tumor in the small intestine that is pressing on the liver. Which type of pain does the nurse anticipate the client will report?

visceral

The nurse is preparing to administer a dose of ketorolac to a 15-year-old adolescent. How should the nurse administer the medication to reduce the potential for gastrointestinal upset?

with meals

When providing education to a parent regarding pain management for a toddler with otitis media, which statement by the parent indicates further teaching is needed?

"I should give my toddler one baby aspirin."

The nurse is caring for a client who is in a sickle cell crisis. The child is hospitalized for pain management during the crisis. The parents tell the nurse that they do not think their child needs any pain medication because the child is sleeping a lot. How should the nurse respond?

"I understand why you think your child is not in pain; sleep is often a way for children to cope with pain."

A young child with leukemia is scheduled for a bone marrow biopsy. The parents have been instructed to apply anesthetic cream to the site prior to the biopsy. Which is the best nursing instruction for the parents?

"Do not let your child remove the dressing because the cream can cause damage if rubbed into the eyes."

A child is being treated for pain. The nurse is obtaining a pain history from the parent. Which question(s) would the nurse ask the parent to obtain the appropriate information about the child's pain? Select all that apply.

"Has your child been in pain before?" "When your child has had pain, how did the child react?" "If your child has been treated for pain, how did the child indicate relief?" "Does your child have chronic pain?" "Is there any sign your child exhibits that makes you believe the child is in pain?"

A nurse is caring for a boy preparing to undergo a dressing change. Which statement by the father lets the nurse know that the child's pain experience is at risk of being intensified?

"I hope that you will be a brave boy and not cry."

A child awaiting a blood draw procedure states, "I am so nervous and really do not want to have this done." Which response by the nurse is best?

"Imagine that you are swimming in a cool, shady pool where nothing can harm you."

The parents of a newborn are deciding if they want their newborn circumcised. The parents ask the nurse if their newborn can feel any pain during the procedure. How should the nurse respond?

"It is hard to know for sure, but research shows that it is possible for newborns to experience pain."

The nurse is caring for a child who is experiencing postoperative pain after having undergone surgery several hours ago. The child's parent reports having taken meperidine for postoperative pain and wonders if that medication would be of benefit to the child. What response by the nurse is indicated?

"Meperidine is associated with toxicity issues in children and is usually avoided."

A 4-year-old child is being prepared for a colonoscopy with intravenous fentanyl and midazolam. What statement by the parents demonstrates understanding of the nurse's teaching about these medications?

"Our child will be sleepy but able to respond and will feel minimal pain."

The nurse is preparing a 6-year-old for a venipuncture. The boy appears anxious and is crying. How can the nurse foster feelings of control to help minimize his anxiety about the procedure?

"Pick your favorite Band-Aid and show me which arm to use."

The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching?

"This can be taken with other medications we have at home that didn't require a prescription."

The nurse is caring for a 9-year-old boy with episodes of chronic pain. The nurse is educating the parents how to help the child manage pain nonpharmacologically. Which statement indicates a need for further teaching?

"We should start the method after he feels pain."

What scenario demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric clients?

After achieving a relaxed state, begin by encouraging the 13-year-old client to imagine walking down a sandy beach and collecting seashells, a favorite activity.

The nurse plans to apply a cream with lidocaine and prilocaine to decrease the pain of an injection. What would be the best technique?

Apply it at least 1 hour before the procedure.

Moderate sedation is a pain-management technique that is used with children. During moderate sedation for a preschooler, which action would be most important?

Assessing vital signs frequently, because they can become depressed

The nurse on a neonatal intensive care unit needs to assess a neonate for pain following a surgical procedure. Which method is best for the nurse to use?

CRIES

The nurse is reviewing the care plan and records of a 14-year-old on the oncology unit who is receiving opioid pain medication. The client normally has a bowel movement on a daily basis, but the client is at tisk for constipation related to opioid analgesic agents. What would be the best goal for this client's risk?

Client will have a soft, formed bowel movement daily.

The nurse is caring for a 12-year-old in sickle cell crisis. The nurse determines that the child is very tense and might benefit from relaxation techniques. Which is the best approach for the nurse to take when implementing this pain reduction technique?

Close the door to the client's room, dim the lights, and close the curtains before beginning.

The nurse is aware of the special needs of children related to pain assessment. What is the priority for the nurse to consider when completing a pain assessment?

Developmental age of child

The nurse is assisting with the administration of the child's initial dose of parenteral opioids. Which action should the nurse take first?

Ensure naloxone is readily available.

The nurse is caring for an infant who was injured in a severe automobile accident. The child experienced several fractures and is in significant pain. The child's mother questions if this will impact her child later in life. What information should be provided by the nurse?

Experiences with pain even in infancy can influence an individual's response to pain later.

When educating a parent on how to support the child while experiencing a painful procedure, what is the best information for the nurse to convey?

Explain in detail the role of the parent as a coach and emphasize the coping plan.

The nurse is caring for a 12-year-old with cerebral palsy who is unable to communicate verbally. Which pain assessment tool is the most appropriate for the nurse to use when assessing pain in this client?

Face, leg, activity, cry, and consolability (FLACC) descriptors

The nurse is preparing a 6-year-old child for a bone marrow biopsy. The child is very anxious about going through this procedure. Which nursing diagnosis best fits this situation?

Fear related to anticipation of painful procedure

Which nursing intervention demonstrates proper use of cutaneous stimulation to relieve pain in pediatric clients?

Gently massaging a preterm infant's leg for 2 minutes prior to obtaining a blood sample from a heel stick.

Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain?

Numeric pain intensity scale

The nurse is caring for a 3-year-old child who has an intravenous line. When medications are delivered through the line the child experiences burning. What action by the nurse will be most helpful?

Sit with the child and use distractions such as toys during the infusion.

The nurse teaches a preschooler to use a FACES pain rating scale prior to surgery. At that time, the preschooler points to the smiling face. Following surgery when the nurse suspects the child has pain, the preschooler points again to the smiling face. How would the nurse interpret this response?

The child is using the scale to predict what they would like, not what the child has.

When assessing a wound for proper anesthetic effect, which finding would indicate the wound would be ready for suturing?

The nurse can visualize a blanching effect.

An experienced pediatric nurse is orienting a new graduate nurse. Which action by the new graduate would require intervention by the experienced nurse?

The nurse offers the medicine to the child and says to "take this liquid candy."

A 12-year-old girl needs a lumbar puncture to collect cerebrospinal fluid for a laboratory exam plus injection of medication into the central nervous system. She expresses great fear of the procedure because of anticipated pain and the inability to hold still. The nurse contacts the physician to make which suggestion?

The use of conscious sedation for the lumbar puncture.

The nurse is providing postsurgical care for a 5-year-old. The nurse knows to avoid which question when assessing the child's pain level?

Would you say that the pain you are feeling is sharp or dull?

A 7-year-old boy tells the nurse that his head sometimes hurts after he eats ice cream. The nurse recognizes that this type of pain is:

acute referred pain

The neonatal nurse is assisting the health care provider with a circumcision. Which pain relief method would be most beneficial?

anesthetic cream

The nurse is caring for a child receiving an epidural opioid medication. The nurse will ensure which medication is readily available for this client?

naloxone

The neonatal nurse is preparing to perform a heel prick for blood work on a 3-day-old infant. Which procedural pain management will the nurse provide the client?

pacifier with oral glucose

A young child is hospitalized with pneumonia. Upon admission the client states not having pain but just a bad cough. A few hours later, the child he begins reporting pain in the right lower back. This first report of feeling pain refers to:

pain threshold

The nurse is preparing to use the FLACC behavioral scale to assess the pain level of a child. For which child will the use of this scale be the most appropriate?

postoperative 6-year-old child who is unable to accurately report pain level

When caring for a child in chronic pain, the focus of nursing interventions should be on:

regaining or achieving developmental tasks and decreasing attention to pain behaviors.