Peds- Chapter 36

The nurse is providing teaching to the parents of a newborn prior to a heelstick. The nurse is describing the procedure and recommending various methods for the parents to help comfort their baby. Which statement by the parents indicates a need for further teaching? A) "It's better if we are not in the room for this." B) "We can use kangaroo care before and after." C) "We hope you are using a very tiny needle." D) "We can offer him nonnutritive sucking to calm him."

A) "It's better if we are not in the room for this." Feedback: Unless contraindicated, the parents should be encouraged to be present before, during, and after the procedure to provide comforting support to the child. Kangaroo care, small-gauge needles, and nonnutritive sucking are other methods to provide atraumatic care.

For which child would nonopioid analgesics be recommended? A) A child with juvenile arthritis B) A child with end-stage cancer C) A child with a broken arm D) A child with severe postoperative pain

A) A child with juvenile arthritis Feedback: Nonopioid analgesics may be used to treat mild to moderate pain, often for conditions such as arthritis; joint, bone, and muscle pain; headache; dental pain; and menstrual pain. Opioid analgesics are typically used for moderate to severe pain as can occur with cancer, broken bones, and postoperative healing.

Prior to administering morphine to a 10-year-old child, the nurse reviews the adverse effects of the drug. Which system is primarily affected by the drug, causing most of the adverse effects? A) Central nervous system B) Peripheral nervous system C) Digestive system D) Musculoskeletal system

A) Central nervous system Feedback: Opioid agonists, such as morphine, are associated with numerous adverse effects, resulting primarily from their depressant action on the central nervous system.

The nurse is managing children who have chronic diseases in a neighborhood clinic. What are some examples of chronic conditions? Select all that apply. A) Diabetes mellitus B) Myocardial infarction C) Rheumatoid arthritis D) Compound fracture E) Acute asthma F) Bronchopneumonia

A) Diabetes mellitus C) Rheumatoid arthritis E) Acute asthma Feedback: Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Diabetes, arthritis, and asthma are examples of chronic pain. Acute pain is defined as pain that is associated with a rapid onset of varying intensity. It usually indicates tissue damage and resolves with healing of the injury. Examples include heart attack, fractures, and bronchopneumonia.

Opioid agents include which of the following: SATA A) Morphine B) Fentanyl (Sublimaze Duragesic) C) Hydromorphone (Dilaudid) D) Oxycodone (OxyContin) E) Methadone F) Heroin

A) Morphine B) Fentanyl (Sublimaze Duragesic) C) Hydromorphone (Dilaudid) D) Oxycodone (OxyContin) E) Methadone

The nurse is caring for a child who is recovering from an appendectomy. What is the appropriate term for the pain this child is experiencing? A) Nociceptive pain B) Neuropathic pain C) Chronic pain D) Superficial somatic pain

A) Nociceptive pain Feedback: Nociceptive pain reflects pain due to noxious stimuli that damages normal tissues or has the potential to do so if the pain is prolonged. Nociceptive pain ranges from sharp or burning; to dull, aching, or cramping; to deep aching or sharp stabbing. Examples of conditions that result in nociceptive pain include chemical burns, sunburn, cuts, appendicitis, and bladder distention. Neuropathic pain is pain due to malfunctioning of the peripheral or central nervous system. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Superficial somatic pain, often called cutaneous pain, involves stimulation of nociceptors in the skin, subcutaneous tissue, or mucous membranes.

Which of the following are pain assessment tools used with children? SATA A) Premature infant pain profile (PIPP) B) Neonatal infant pain scale (NIPS) C) Riley Infant pain scale (RIPS) D) Pain observation scale for young children (POCIS) E) FACES scale F) CRIES scale for neonatal postoperative pain assessment G) r-FLACC behavioral scale for pain in nonverbal young children and children with cognitive impairment H) Scale of 1-10 for pain

A) Premature infant pain profile (PIPP) B) Neonatal infant pain scale (NIPS) C) Riley Infant pain scale (RIPS) D) Pain observation scale for young children (POCIS) F) CRIES scale for neonatal postoperative pain assessment G) r-FLACC behavioral scale for pain in nonverbal young children and children with cognitive impairment

The nurse is researching behavioral-cognitive pain relief strategies to use on a 5-year-old child with unrelieved pain. Which methods might the nurse choose? Select all that apply. A) Relaxation B) Distraction C) Thought stopping D) Massage E) Sucking

A) Relaxation B) Distraction C) Thought stopping Feedback: Common behavioral-cognitive strategies include relaxation, distraction, imagery, thought stopping, and positive self-talk. Sucking and massage are examples of biophysical interventions.

The nurse is caring for a child who is experiencing pain related to chemotherapy treatment. What is a behavioral factor that might affect the child's pain experience? A) Knowledge of the therapy B) Fear about the outcome of therapy C) Participation in normal routine activities D) Ability to identify pain triggers

C) Participation in normal routine activities Feedback: Participation in normal routine activities is a behavior factor. Knowledge of the therapy and ability to identify pain triggers are cognitive factors. Fear about the outcome of therapy is an emotional factor. Situational factors involve factors or elements that interact with the child and his or her current situation involving the experience of pain.

This type of opioid is used for intractable pain, or for preoperative sedation in children. It may cause itching, particularly facial. You should assess respiratory status frequently, monitor for sedation, dizziness, lethargy, or confusion. Institute safety measures to prevent injury to the child. Educate parents and child that the drug may make the child sleepy, light headed, or drowsy. Assess bowel sounds for decreased peristalsis- observe for abdominal distention. Ensure adequate fiber intake and administer stool softeners as prescribed to minimize risk for constipation. Monitor urine output for changes and report.

Morphine

This pain scale is a behavioral assessment tool that is useful for measuring pain in pre- and full-term neonates. Six parameters are measured: facial expression, cry, breathing patterns, arms, legs, and state of arousal. Each parameter except for cry is scored a 0-1; cry 0-2. Scores are totaled and max score that can be reached is a 7. Higher score=increased pain.

Neonatal Infant Pain Scale (NIPS)

Pain due to malfunctioning of peripheral or central nervous system. It may be continuous or intermittent and is commonly described as burning, tingling, shooting, squeezing, or spasm-like pain. Examples include: post-traumatic and post-surgical peripheral nerve injuries, pain after spinal cord injury, metabolic neuropathies, phantom limb pain after amputation, and poststroke pain.

Neuropathic pain

Reflects pain due to noxious stimuli that damages normal tissues or has the potential to do so if the pain is prolonged. Ranges from sharp/burning, to dull, aching, or cramping, and to deep aching or sharp stabbing. Examples include: chemical burns, sunburns, cuts, appendicitis, and bladder distention.

Nociceptive pain

The student nurse is learning about the effects of heat and cold when used in a pain management plan. What accurately describes one of these effects? A) Cold results in vasodilation. B) Cold alters capillary permeability. C) Heat results in vasoconstriction. D) Heat decreases blood flow to the area.

B) Cold alters capillary permeability. Feedback: Cold results in vasoconstriction and alters capillary permeability, leading to a decrease in edema at the site of the injury. Heat results in vasodilation and increases blood flow to the area.

The nurse tells a joke to a 12-year-old to distract him from a painful procedure. What pain management technique is the nurse using? A) Relaxation B) Distraction C) Imagery D) Thought stopping

B) Distraction Feedback: Distraction involves having the child focus on another stimulus, thereby attempting to shield him from pain. Humor has been demonstrated to be an effective distracting technique for pain management.

The nurse is explaining the effects of heat application for pain relief. Which effect would the nurse be likely to include? A) Decreased blood flow to the area B) Increased pressure on nociceptive fibers C) Possible release of endogenous opioids D) Altered capillary permeability

B) Increased pressure on nociceptive fibers Feedback: Heat causes an increase in blood flow. This alters capillary permeability, leading to a reduction in swelling and pressure on nociceptive fibers. Heat also may trigger the release of endogenous opioids, which mediate the pain response.

Pain classified by etiology is ________________ or _________________.

Nociceptive pain or Neuropathic pain

A behavioral assessment tool for children from 1-4 years old to assess pain. Measures 7 parameters: facial expression, cry, breathing, torso, arms and fingers, legs and toes, and state of arousal. Each is scored from 0-1; max score achieved is 7. Higher the score=greater the pain.

Pain Observation Scale for Young Children (POCIS)

This pain scale is useful for measuring pain in term/preterm neonates. It looks at behavioral indicators, such as facial expressions, and physiologic changes such as heart rate, 02 saturation, and takes into account gestational age. Each parameter is scored from 0-3. Score is totaled and max score achieved is 21. Higher the total score=more intense the pain.

Premature Infant Pain Profile (PIPP)

This is a behavioral assessment tool to assess pain; useful for infants who lack verbal ability. Measures 6 parameters: facial expression, body movement, sleep, verbal/vocal ability, consolability, and response to movements and touch. Each parameter is scored from 0-3. Score is totaled and max score achieved is 18. Higher total score=more intense pain.

Riley Infant Pain Scale (RIPS)

Pain developed in the tissues that can be superficial or deep. Pain is well localized and described as sharp, pricking, or burning sensation.

Somatic

Superficial ____________ pain may be due to external mechanical, chemical, or thermal injury or skin disorders.

Somatic

Pain classified by source or location is either _____________ or ______________ pain.

Somatic or Visceral

Pain that develops within organs such as the heart, lungs, GI tract, pancreas, liver, gallbladder, kidneys, or bladder. Often produced by disease. May be due to distention of the organ, organ muscular spasm, contraction, pulling, ischemia, or inflammation. Tenderness, nausea, vomiting, and diaphoresis may be present.

Visceral pain

Useful pain scale when child cannot report accurately his/her level of pain. Demonstrated reliable tool for children 6 months-7 years of age. Measures 5 parameters: facial expression, legs, activity, cry, and consolability. Max score of 10, Higher score=greater pain.

r-FLACC Scale for pain in nonverbal young children and children with cognitive impairment

The nurse has applied EMLA cream as ordered. How does the nurse assess that the cream has achieved its purpose? A) Assess the skin for redness. B) Note any blanching of skin. C) Lightly tap the area where the cream is. D) Gently poke the child with a needle.

C) Lightly tap the area where the cream is. Feedback: The nurse should verify that sensation is absent by lightly tapping or scratching the area. Blanching or redness indicates that the medication has penetrated the skin adequately but does not indicate that sensation is absent. Using a needle to poke the skin would likely frighten the child.

The nurse is assessing the pain of a postoperative newborn. The nurse measures the infant's facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. Which behavioral assessment tool is being used by the nurse? A) Riley Infant Pain Scale B) Pain Observation Scale for Young Children C) CRIES Scale for Neonatal Postoperative Pain Assessment D) FLACC Behavioral Scale for Postoperative Pain in Young Children

A) Riley Infant Pain Scale Feedback: The Riley Infant Pain Scale measures six parameters: facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. The Pain Observation Scale for Young Children (POCIS) measures seven parameters: facial expression, cry, breathing, torso, arms and fingers, legs and toes, and state of arousal. The CRIES tool assesses five parameters: cry, oxygen required for saturation levels less than 95%, increased vital signs, facial expression, and sleeplessness. The FLACC tool measures five parameters: facial expression, legs, activity, cry, and consolability.

The nurse is preparing to administer a topical anesthetic for a 10-year-old girl with a chin laceration. The nurse would expect to apply what as ordered in preparation for sutures? A) TAC (tetracaine, epinephrine, cocaine) B) Iontophoretic lidocaine C) EMLA D) Vapocoolant spray

A) TAC (tetracaine, epinephrine, cocaine) Feedback: TAC (tetracaine, epinephrine, cocaine) is commonly used for lacerations that require suturing. The agent can be applied directly to the wound with a cotton ball or swab for 20 to 30 minutes until the area is numb. EMLA and iontophoretic lidocaine are applied to intact skin, not to open wounds or lacerations. A vapocoolant spray, which should not be applied over a wound, is only effective for 1 to 2 minutes.

THE NURSE'S ROLE IN NON-PHARMACOLOGICAL intervention include: SATA A) Teaching the child/family about the nonpharmacological pain interventions B) Help the child/family choose the most appropriate and effective methods C) Ensure the child and parents use the methods BEFORE pain occurs as well as BEFORE the pain increases. D) Assist the child and parents when using the technique in order to make sure that they are using the technique correctly. E) Offer suggestions for modifications or adaptations as necessary F) Ensure the child and parents use the methods AS SOON AS pain begins, but not BEFORE.

A) Teaching the child/family about the nonpharmacological pain interventions B) Help the child/family choose the most appropriate and effective methods C) Ensure the child and parents use the methods BEFORE pain occurs as well as BEFORE the pain increases. D) Assist the child and parents when using the technique in order to make sure that they are using the technique correctly. E) Offer suggestions for modifications or adaptations as necessary

The nurse caring for infants in the neonatal intensive care unit (NICU) relies on the use of behavioral and physiologic indicators for determining pain. Which examples are behavioral indicators? Select all that apply. A) The infant grimaces. B) The infant's heart rate is elevated. C) The infant flails his arms and legs. D) The infant's respiratory rate is elevated. E) The infant is crying uncontrollably. F) The infant's oxygen saturation is low.

A) The infant grimaces. C) The infant flails his arms and legs. E) The infant is crying uncontrollably. Feedback: In preterm and term newborns, behavioral and physiologic indicators are used for determining pain. Behavioral indicators include facial expression, body movements, and crying. Physiologic indicators include changes in heart rate, respiratory rate, blood pressure, oxygen saturation levels, vagal tone, palmar sweating, and plasma cortisol or catecholamine levels.

Follow these guidelines when applying EMLA: SATA A) Explain the purpose of the medication to child and parents, reinforcing that it will help the pain go away. B) Check the scheduled time for the procedure; plan to apply cream 60 mins prior to a superficial procedure such as an IM injection or venipuncture or 2-3 hours before deeper procedure- like lumbar puncture or bone marrow aspiration. C) Place a thick layer of cream on skin at intended site of procedure, make sure area where cream is being applied is free of any breaks. Do not rub cream in once its applied to skin. D) Cover the site with a transparent dressing- Tegaderm or Opsite and secure it so the dressing is occlusive. E) Instruct child to not touch the dressing once it's secured. May cover with protection device or loosely applied gauze or elastic bandage. F) After allotted time, remove the occlusive dressing and wipe cream from skin. Inspect skin for a change in color (blanching/redness), which indicates that the medication has penetrated the skin adequately. G) Verify that sensation is absent by lightly tapping/scratching the area. Use this technique to also demonstrate to child that the anesthetic is effective. If sensation is present, then reapply cream. H) Verify that sensation is absent by pricking child with needle in area. If sensation is present, have them take the meds by mouth. I) Prepare the child for the procedure. Assess the child's pain after the procedure to evaluate for pain and differentiate pain from fear and anxiety.

ALL BUT H A) Explain the purpose of the medication to child and parents, reinforcing that it will help the pain go away. B) Check the scheduled time for the procedure; plan to apply cream 60 mins prior to a superficial procedure such as an IM injection or venipuncture or 2-3 hours before deeper procedure- like lumbar puncture or bone marrow aspiration. C) Place a thick layer of cream on skin at intended site of procedure, make sure area where cream is being applied is free of any breaks. Do not rub cream in once its applied to skin. D) Cover the site with a transparent dressing- Tegaderm or Opsite and secure it so the dressing is occlusive. E) Instruct child to not touch the dressing once it's secured. May cover with protection device or loosely applied gauze or elastic bandage. F) After allotted time, remove the occlusive dressing and wipe cream from skin. Inspect skin for a change in color (blanching/redness), which indicates that the medication has penetrated the skin adequately. G) Verify that sensation is absent by lightly tapping/scratching the area. Use this technique to also demonstrate to child that the anesthetic is effective. If sensation is present, then reapply cream. I) Prepare the child for the procedure. Assess the child's pain after the procedure to evaluate for pain and differentiate pain from fear and anxiety.

Teaching to manage pain without drugs (non-pharmacologic pain interventions) include: SATA A) Review the methods available and choose the method(s) that your child and you find best for the situation. B) Learn to identify the ways in which your child shows pain/demonstrates they're anxious about the possibility of pain. Do they get restless, make a face, or get flushed in the face? C) Begin using the technique chosen before your child experiences pain or when your child first indicates they're anxious about pain, or beginning to experience pain. D) Practice the technique with your child and encourage the child to use the technique when they feel anxious about pain/anticipates that a procedure/experience will be painful. E) Perform the technique with your child. For ex- take a deep breath in and out or blow bubbles with them; listen to music/play the game with your child. F) Avoid using terms such as "hurt" or "pain" that suggest/cause your child to expect pain. G) Use descriptive terms like "pushing" or "pulling", "pinching" or "heat". H) Avoid overly descriptive or judgmental statements such as, "This will really hurt a lot" or "This will be terrible" I) Stay with your child as much as possible; speak softly and gently stroke or cuddle your child. J) Offer praise, positive reinforcement, hugs, and support for using the technique even when it wasn't effective.

ALL OF THE ABOVE A) Review the methods available and choose the method(s) that your child and you find best for the situation. B) Learn to identify the ways in which your child shows pain/demonstrates they're anxious about the possibility of pain. Do they get restless, make a face, or get flushed in the face? C) Begin using the technique chosen before your child experiences pain or when your child first indicates they're anxious about pain, or beginning to experience pain. D) Practice the technique with your child and encourage the child to use the technique when they feel anxious about pain/anticipates that a procedure/experience will be painful. E) Perform the technique with your child. For ex- take a deep breath in and out or blow bubbles with them; listen to music/play the game with your child. F) Avoid using terms such as "hurt" or "pain" that suggest/cause your child to expect pain. G) Use descriptive terms like "pushing" or "pulling", "pinching" or "heat". H) Avoid overly descriptive or judgmental statements such as, "This will really hurt a lot" or "This will be terrible" I) Stay with your child as much as possible; speak softly and gently stroke or cuddle your child. J) Offer praise, positive reinforcement, hugs, and support for using the technique even when it wasn't effective.

Pain is classified by duration as _______________ or _______________.

Acute or chronic

Pain that is associated with a rapid onset of varying intensity. Usually indicates tissue damage and resolves with healing of the injury. Examples include: trauma, invasive procedures, acute illnesses such as sore throat or appendicitis, and surgery. Typically lasts a few days.

Acute pain

The nurse is caring for a child who reports chronic pain. What is the priority nursing assessment? A) How the pain impacts the child's and family's stress level B) The pain's history, onset, intensity, duration, and location C) The child's and parents' feeling of anxiety and depression D) The child's cognitive level and emotional response

B) The pain's history, onset, intensity, duration, and location Feedback: Assessment of the child's pain is key; it is the priority assessment and is the only answer that focuses on the child's physiologic need. Assessment of how the pain impacts the child's and family's stress, feelings of anxiety, hopelessness, and depression, as well as the child's cognitive level and emotional response, are secondary after the pain is explored.

When the nurse is assessing a child's pain, which is most important? A) Obtaining a pain rating from the child with each assessment B) Using the same tool to assess the child's pain each time C) Documenting the child's pain assessment D) Asking the parents about the child's pain tolerance

B) Using the same tool to assess the child's pain each time Feedback: Although obtaining a pain rating, documenting the assessment, and asking the child's parents about the pain are important, the most important aspect of pain assessment is to use the same tool each time so that appropriate comparisons can be made and effective interventions can be planned and implemented. Consistency allows the most accurate assessment of the child's pain.

The nurse is teaching the student nurse the physiology involved in pain transmission. Which statements accurately describes a physiologic event in the nervous system related to pain transmission? Select all that apply. A) Thermal stimulation may involve the release of mediators, such as histamine, prostaglandins, leukotrienes, or bradykinin. B) When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed to the spinal cord and brain. C) Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. D) Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. E) The point at which the person first feels the highest intensity of the painful stimulus is termed the pain threshold. F) Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain.

B) When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed to the spinal cord and brain. C) Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. D) Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. F) Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain. Feedback: When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed along the peripheral nerves to the spinal cord and brain. Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain. Chemical stimulation may involve the release of mediators, such as histamine, prostaglandins, leukotrienes, or bradykinin. The point at which the person first feels the lowest intensity of the painful stimulus is termed the pain threshold.

A nurse is providing teaching to the mother of an adolescent girl about how to manage menstrual pain nonpharmacologically. Which statements by the mother indicates a need for further teaching? A) "I need to help her learn techniques to distract her; card games, for example." B) "I need to be able to identify the subtle ways she shows pain." C) "I need to follow these instructions exactly for them to work properly." D) "I need to encourage her to practice and utilize these techniques."

C) "I need to follow these instructions exactly for them to work properly." Feedback: The mother does not need to follow the instructions exactly; she needs to review the methods and modify them in a way that works best for her daughter. The other statements are correct.

The nurse is teaching an 8-year-old child and his family how to manage cancer pain using non-pharmacologic methods. Which parent statement signifies successful child teaching? A) "I will avoid using descriptive words like pinching, pulling, or heat." B) "I will not use positive reinforcement until the technique is perfected." C) "I will begin using the technique before he experiences pain." D) "I will be honest and tell him that the procedure will hurt a lot."

C) "I will begin using the technique before he experiences pain." Feedback: The parents should begin using the technique chosen before the child experiences pain or when the child first indicates he is anxious about, or beginning to experience, pain. The parents should use descriptive terms like pushing, pulling, pinching, or heat and avoid overly descriptive or judgmental statements such as, "This will really hurt a lot" or "This will be terrible." They should offer praise, positive reinforcement, hugs, and support for using the technique even when it was not effective.

The nurse is preparing a child for a lumbar puncture. How far ahead of the procedure should the nurse apply the EMLA cream? A) 30 minutes B) 1 hour C) 3 hours D) 4 hours

C) 3 hours Feedback: For a deeper procedure such as a lumbar puncture, the nurse needs to apply the cream 2 to 3 hours before the procedure. For a superficial procedure, the EMLA cream should be applied at least 1 hour before the procedure.

The nurse is administering pain medication for a child with continuous pain from internal injuries. Which method would be ordered to dispense the medication? A) Administer the medication PRN (as needed). B) Administer the mediation when pain has peaked. C) Administer the medication around the clock at timed intervals. D) Administer the medication when the child reports pain.

C) Administer the medication around the clock at timed intervals. Feedback: With any medication administered for pain management, the timing of administration is vital. Timing depends on the type of pain. For continuous pain, the current recommendation is to administer analgesia around the clock at scheduled intervals to achieve the necessary effect. As-needed or PRN dosing is not recommended for continuous pain. This method can lead to inadequate pain relief because of the delay before the drug reaches its peak effectiveness. For pain that can be predicted or considered temporary, such as with a procedure, analgesia is administered so that the peak action of the drug matches the time of the painful event. It is not recommended to wait until the child complains of pain because therapeutic levels will be difficult to reach at this point.

A behavioral assessment tool that also includes measures of physiologic parameters. Quantifies postoperative pain in newborns and also to monitor the infant's progress over time during recovery or after interventions. Assesses 5 parameters: cry, oxygen required for saturation levels less than 95%, increased vital signs, facial expressions, and sleeplessness. Each parameter is scored as 0-2 then totaled. Higher score=more pain.

CRIES Scale for neonatal postoperative pain assessment

Pain that continues past the expected point of healing for injured tissue. May be continuous or intermittent, with and w/o periods of exacerbation or remission. Commonly associated with abdominal pain, nonspecific headache, limb pain, or chest pain.

Chronic pain

The nurse is counseling the parents of a 9-year-old boy who is receiving morphine for postoperative pain. Which statement from the nurse accurately reflects the pain experience in children? A) "You can expect that your child will tell you when he is experiencing pain." B) "Your child will learn to adapt to the pain he is experiencing." C) "Your child will experience more adverse effects to narcotics than adults." D) "It is very rare that children become addicted to narcotics."

D) "It is very rare that children become addicted to narcotics." Feedback: Addiction to narcotics when used in children is very rare. Often children deny pain to avoid a painful situation or procedure, embarrassment, or loss of control. Repeated exposure to pain or painful procedures can result in an increase in behavioral manifestations. The risk of adverse effects of narcotic analgesics is the same for children as for adults.

The nurse is providing instructions to a mother on how to use thought stopping to help her child deal with anxiety and fear associated with frequent painful injections. Which statement indicates the mother understands the technique? A) "We will imagine that we are on the beach in Florida." B) "We can talk about our favorite funny movie and laugh." C) "She can let her body parts go limp, working from head to toe." D) "We'll repeat 'quick stick, feel better, go home soon' several times."

D) "We'll repeat 'quick stick, feel better, go home soon' several times." Feedback: Thought stopping is a technique that involves the use of short, concise phrases of positive ideas. Doing so helps to promote the child's sense of control. Imagining a favorite beach in Florida is using imagery. Talking about a favorite funny movie involves humor. Letting body parts go limp is a relaxation technique.

The nurse is conducting an assessment of a high school track athlete. The client tells the nurse he is experiencing pain along his outer thigh. He describes it as tight, achy, and tender, particularly after he runs. The nurse understands that he is most likely experiencing what kind of pain? A) Cutaneous B) Neuropathic C) Visceral D) Deep somatic

D) Deep somatic Feedback: Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones. It can be localized or diffuse and is usually described as dull, aching, or cramping with tenderness. It can also be due to overuse injuries commonly experienced by athletes. Cutaneous pain usually involves the skin and is described as sharp or burning. Neuropathic pain is due to a malfunctioning of the peripheral nervous system and is described as burning or tingling. Visceral pain is pain that develops within organs.

Pentazocine is prescribed for a child with moderate pain. The nurse identifies this drug as an example of which type? A) Nonsteroidal anti-inflammatory drug (NSAID) B) Prostaglandin inhibitor C) Opioid D) Mixed opioid agonist-antagonist

D) Mixed opioid agonist-antagonist Feedback: Pentazocine is classified as a mixed opioid agonist-antagonist. Ibuprofen, ketorolac, and naproxen are examples of NSAIDs that inhibit prostaglandin synthesis. Morphine, codeine, and fentanyl are examples of opioids.

Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain? A) FACES pain rating scale B) Oucher pain rating scale C) Poker chip tool D) Numeric pain intensity scale

D) Numeric pain intensity scale Feedback: The numeric pain intensity scale can be used with children as young as 5 years of age, but the preferred minimum age for using this tool is 7 years. The FACES and Oucher pain rating scales and the poker chip tool are appropriate pain assessment tools for a 4-year-old.

The nurse is conducting a pain assessment of a 10-year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action? A) Increase the dosage of the acetaminophen. B) Tell the child he is experiencing the ceiling effect. C) Use guided imagery to help his pain. D) Obtain an order for a different medication.

D) Obtain an order for a different medication. Feedback: Increasing the dose of the acetaminophen will not help his pain because he has reached as high a dose of that medication that will work. This is known as the ceiling effect, but explaining that to him will not help his pain. Guided imagery is not the best therapy for his pain, so the physician needs to order a different medication to manage his pain.

The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which adverse effect of the medication? A) Epidural hematoma B) Arachnoiditis C) Spinal headache D) Respiratory depression

D) Respiratory depression Feedback: The nurse needs to monitor for signs of respiratory depression, a potential adverse effect of the opioid medication. Epidural hematoma, arachnoiditis, and spinal headache are potential adverse effects of the insertion of the epidural catheter.

The nurse is using the acronym QUESTT to assess the pain of a child. Which is an accurate descriptor of this process? A) Question the child's parents. B) Understand the child's pain level. C) Establish a caring relationship with the child. D) Take the cause of pain into account when intervening.

D) Take the cause of pain into account when intervening. Feedback: The acronym QUESTT stands for the following: Question the child. Use a reliable and valid pain scale. Evaluate the child's behavior and physiologic changes to establish a baseline and determine the effectiveness of the intervention. The child's behavior and motor activity may include irritability and protection as well as withdrawal of the affected painful area. Secure the parent's involvement. Take the cause of pain into account when intervening. Take action.

The nurse uses the FLACC behavioral scale to assess a 6-year-old's level of postoperative pain and obtains a score of 9. The nurse interprets this to indicate that the child is experiencing: A) Little to no pain. B) mild pain. C) moderate pain. D) severe pain.

D) severe pain. Feedback: With the FLACC behavioral scale, five parameters are measured and scored as 0, 1, or 2. They are then totaled to achieve a maximum score of 10. The higher the score, the greater the pain. A score of 9 indicates severe pain.

___________ somatic pain typically involves the muscles, tendons, joints, fasciae, and bones. May be due to strain from overuse or direct injury, ischemia, and inflammation.

Deep

This type of opioid is used for pain associated with short procedures such as bone marrow aspiration, fracture reductions, suturing. Observe for chest wall rigidity, which can occur with rapid IV infusion. You should assess respiratory status frequently, monitor for sedation, dizziness, lethargy, or confusion. Institute safety measures to prevent injury to the child. Educate parents and child that the drug may make the child sleepy, light headed, or drowsy. Assess bowel sounds for decreased peristalsis- observe for abdominal distention. Ensure adequate fiber intake and administer stool softeners as prescribed to minimize risk for constipation. Monitor urine output for changes and report.

Fentanyl