Perry Chapter 30: Pain Assessment and Management in Children

4 The most appropriate medications for minor pain (< 3 on the pain scale) are nonsteroidal antiinflammatory drugs and morphine. Percodan contains aspirin, which is contraindicated in young children because it may cause Reye's syndrome. Drugs such as codeine, acetaminophen, and morphine can be safely prescribed in the children because these drugs do not contain aspirin. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress.

A 1-year-old child is suffering from minor pain after a fall. Using a behavioral pain assessment scale, the nurse rates the child's pain at 2 on a 0 -10 pain scale. Which medication should the nurse question in the prescription? 1 Codeine sulfate (Codeine) 2 Acetaminophen (Tylenol) 3 Morphine (Avinza) 4 Oxycodone with aspirin (Percodan)

2, 3, 4 Administration of Colace, a stool softener, can help prevent constipation . Increased fluid and fruit intake (high fiber content) can help prevent constipation. Increased activity helps stimulate peristalsis. Diphenhydramine does not increase peristalsis or prevent constipation.

A 6-year-old is hospitalized with a fractured femur. Based on the nurse's knowledge of opioid side effects, which actions should the nurse include in the patient's plan of care to prevent constipation? Select all that apply. 1 Instruct the child to remain supine while in bed. 2 Administer docusate sodium (Colace). 3 Encourage fluid intake. 4 Encourage the child to eat fruit. 5 Administer diphenhydramine (Benadryl).

2 Postdural puncture headache is a common complication after a lumbar puncture. In this scenario, the nurse should position the patient properly. The nurse should make this patient lie down in the supine position for 1 hour after the procedure. Twenty minutes is insufficient to relieve the headache. Sitting or walking around will not relieve the headache.

A child has undergone a lumbar puncture for chemotherapy. As a result, this child has developed a postdural puncture headache. How should the nurse position this child in order to relieve the postdural puncture headache? 1 Sitting position for 1 hour after the procedure 2 Supine position for 1 hour after the procedure 3 Supine position for 10 minutes after the procedure 4 Walking slowly for 20 minutes after the procedure

2 Pruritus, sedation, dysphoria, and respiratory depression are side effects of opioid therapy. Methylphenidate (Methylin) is given as an adjuvant drug to reduce the sedation caused by opioids. Hydroxyzine (Hypam) is used to treat pruritus. Haloperidol (Haldol) is used to treat dysphoria. Naloxone (Narcan) is used to treat respiratory depression.

A child who is on opioid therapy has come for a follow-up visit to a pain clinic. After assessment, the health care provider adds methylphenidate (Methylin) to the child's regimen. What could be the reason for adding this drug? The child had: 1 pruritus. 2 experienced sedation. 3 dysphonia. 4 respiratory depression.

1, 3 Preemptive analgesia is a treatment in which local or regional anesthetics and analgesics are administered to the child before a surgery such as appendectomy. It helps reduce postoperative pain and shortens hospital stays. It reduces the need for analgesics by reducing pain in children. Preemptive analgesia does not affect the success of the surgery. Preemptive analgesia has no effect on neuropathic pain, which is seen mostly in patients with cancer.

A child with appendicitis has been treated with preemptive analgesia before undergoing appendectomy. What would be the benefits of this treatment to the child? Select all that apply. 1 It decreases postoperative pain. 2 It increases the need for analgesics. 3 It reduces the length of the patient's hospital stay. 4 It improves the success of surgery. 5 It decreases the risk of neuropathic pain.

2, 3, 4 A child can be very uncomfortable and irritable during teething. The best intervention is the application of anesthetic gels that are available in the market for teething. The discomfort can also be reduced with the use of frozen rings and bread or hard crackers that the child can chew on. Morphine is prescribed by health care practitioners in cases of severe pain and is not recommended for teething. It is inappropriate to rub wine on the child's gums.

A mother reports that her baby is teething and is very uncomfortable. What measures should the nurse suggest to the mother to relieve the baby's discomfort? Select all that apply. 1 Administer morphine (Avinza) 2 Use frozen teething rings 3 Give the child a hard cracker or bread 4 Use anesthetic gels available for teething 5 Rub some wine on the child's gums and cheeks

2 If the patient reports having no pain relief for the prescribed dosage of opioids, it indicates that the patient has developed opioid tolerance. In this condition the dosage may be increased to provide effective pain relief to the patient. If the patient feels the need to administer the drugs without cause (pain), then the patient has opioid addiction or opioid dependence. Depression, lacrimation, irritability, and anorexia are symptoms of opioid withdrawal.

A patient who is on opioid therapy reports having no pain relief from the previously prescribed dosage. The primary health care provider increases the dosage. What is the reason for increasing the dosage? The patient has symptoms of opioid: 1 addiction. 2 tolerance. 3 dependence. 4 withdrawal.

3 Pentazocine is a mixed opioid agonist and tends to precipitate withdrawal symptoms. Therefore, this medication is avoided in patients who are treated on opioids such as morphine for a long time. Pentazocine has an analgesic action; it does not increase penis pain. Sickle cell anemia is hereditary disorder and is not caused by medications such as pentazocine. Pentazocine is not contraindicated in patients with erectile dysfunction.

A patient with erectile dysfunction is on long-term morphine (Avinza) therapy for relief of priapism (penis pain). After a few months, the patient reports severe penis pain. The primary health care provider increases the dosage of morphine instead of prescribing pentazocine (Talwin). What is the reason for not prescribing pentazocine? The medication: 1 lacks analgesic activity and increases pain. 2 causes sickle cell anemia. 3 precipitates withdrawal syndrome. 4 is contraindicated in erectile dysfunction.

3 Pentazocine is a mixed opioid agonist and antagonist. Sudden discontinuation of the medication causes withdrawal symptoms. The symptoms of opioid withdrawal are severe sweating, tears (lacrimation), and rhinorrhea, which is characterized by runny nose and nasal irritation. The symptoms of drug overdose (opioid overdose) are sedation, respiratory depression, nausea, and vomiting. Drug addiction (opioid addiction) and drug dependence (opioid dependence) are characterized by strong desire or sense of compulsion to take the drug, suicidal ideation, and depression.

A patient with severe pain was prescribed pentazocine (Talwin). After few weeks the patient tells the nurse that she has severe sweating, tears, a runny nose, and nasal irritation. What is the most likely reason for the patient to have these symptoms? Drug: 1 Overdose 2 Addiction 3 Withdrawal 4 Dependence

1, 5 Containment is a nonpharmacological approach that helps the child feel secure and reduces stress. It can help the infant settle down and stop crying. This therapy is not performed to keep the child awake, and in fact it can help the child sleep. Containment is intended to reduce or maintain the heart beat, not increase it.

After administering an injection, the nurse provides containment by covering the infant with a blanket roll. What are the probable reasons for this nursing intervention? Select all that apply. 1 To decrease stress 2 To keep the child awake 3 To increase the heart rate 4 To make the child feel warm 5 To make the infant feel secure

2 The FACES scale has been validated for children as young as 3 years old to rate pain. The child points to the face that best describes the pain being experienced. The scale is useful for all ages above 3 years, including adults. The scale does not have a means of assessing physiologic data.

An important consideration when using the FACES pain rating scale with children is: 1 that children color the face with the color they choose to best describe their pain. 2 the scale can be used with most children, including those as young as 3 years old. 3 the scale is not appropriate for use with adolescents. 4 the scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

4 The Adolescent Pediatric Pain Tool is a multidimensional scale where intensity, quality, and type of pain are assessed; it is available in a Spanish version. The Bieri scale is a face scale where pain is assessed with faces. It does not assess the intensity, quality, and type of pain. The Oucher Pain Scale was developed to assess pain intensity in children who do not communicate in English and is designed to avoid cultural influences in pain management. The numeric rating scale uses numeric ratings on a line from 0 to 10 to measure pain intensity.

The nurse assesses a Spanish-speaking child who is undergoing chemotherapy to determine the intensity, quality, and type of pain. Which scale might the nurse be using? 1 Bieri scale 2 Oucher Pain Scale 3 numeric rating scale 4 Adolescent Pediatric Pain Tool

1 The assessment tool in which a child's school functioning is noted, PedsQL, is usually used for assessing chronic pain. Migraine pain is chronic or recurrent and may have a major impact on the child's performance in school. Skin burns, surgeries such as appendectomies, and orthopedic injury are all associated with acute pain, and assessment of acute pain does not include the assessment of the child's performance in school.

The nurse assesses pain in a child by determining the child's functioning in school as one of the assessment parameters. What type of pain is the nurse assessing in the child? Pain due to: 1 Migraine 2 Skin burns 3 Appendectomy 4 Orthopedic injury

1 The scale that measures the child's vocal, social, facial, activity, body, and physiologic signs is called the Non-Communicating Children's Pain Checklist. This tool is used when a child is not able to communicate. A child with brain injury would probably be unable to communicate. A child with orthopedic injury may not need non-communicating measurements of pain. Pain associated with lumbar puncture is temporary, and non-communicating techniques usually are not needed. Pain due to chemotherapy is generally treated with opioids, and a pain scale that uses verbal communication is most commonly used for patients with cancer.

The nurse assesses pain in a child through vocal, social, facial, activity, body, and physiologic signs and rates the pain as an 8. What pain type does the child have? 1 brain injury 2 orthopedic injury 3 lumbar puncture 4 pain due to chemotherapy

4 Respiratory depression is the most common side effect of opioid therapy. Opioid therapy does not cause brain death. Opioids can cause urinary retention, but they do not cause kidney damage because they do not impair renal function. Opioids do not impair liver function, so they do not cause hepatic failure.

The nurse is assessing a child who is on opioid therapy for pain. Which adverse effect should the nurse be aware of in the patient? 1 Brain death 2 Kidney failure 3 Hepatic failure 4 Respiratory depression

3 The RIPS is used to assess pain in children with cerebral palsy. The rating is based on changes in the child's behavior due to pain. If the child is restless and is frowning or grimacing, the nurse should assign a rating of 1. If the child is thrashing his arms, jerking during sleep, and screaming loudly when touched, then the nurse should assign a rating of 3. If the child is clenching his teeth or cries when touched, then the nurse should assign a rating of 2. Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely.

The nurse is assessing pain in a child with cerebral palsy using the Riley Infant Pain Scale (RIPS). The nurse documents that the child has severe pain and gives a rating of 1 according to the RIPS. What behavior did the nurse find in the child? The child is: 1 thrashing his arms. 2 jerking during sleep. 3 restless and frowning. 4 clenching his teeth.

4 The FLACC pain assessment tool is used to assess pain. Using this scale, the nurse notes each behaviors and rates them. The variables include face, leg, activity, cry, and consolability. The child has a disinterested face, is restless, and is consoled by hugging. The nurse rates each behavior as 1, and the sum yields a score of 3. If the child has no facial expression or has a smiling face with a normal sleep pattern, then the score is 0. A score of 1 is given for variables such as grimacing, restlessness, squirming, moaning, and distractibility. Variables such as constant frowning, kicking, jerking, steady crying, and difficulty being consoled are assigned a score of 2.

The nurse is assessing the behavior of a child with pain using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The nurse notes that the child is restless and maintains a disinterested face. However, the child is consolable by hugging. What score does the nurse give the child based on FLACC scale? 1. 0 2. 1 3. 2 4. 3

1 A psychological consultation will assist the child in verbalizing fears. This age-group is very concerned with physical appearance. The psychologist can help integrate the issues the child is facing. It is likely that the child is having pain but not acknowledging the pain. Speaking with a psychologist might assist the child in relaying fear and pain. If the child is feeling pain, the nurse should not offer praise for hiding the pain. The nurse should encourage the child to speak up during painful episodes so that the pain can be managed appropriately. Bravery may not be an effective coping strategy if the child is in severe pain.

The nurse is caring for a 12-year-old child who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action? 1 Request a psychological consultation. 2 Ask why the child does not have pain. 3 Praise the child for the ability to withstand pain. 4 Encourage continued bravery as a coping strategy.

1, 4, 5 Crying is the most common manifestation of underlying pain. The child can have furrowed brow, puckered lips, clenched teeth, and turning down of mouth as outward signs of pain. Drowsiness and confused looks are not common body signs to express pain.

The nurse is caring for a 2-year-old child who returns to the hospital floor after undergoing an operation. Which nonverbal action implies that the child is in pain? Select all that apply. 1 Loud crying 2 Drowsiness 3 Confused look 4 Furrowed brow 5 Puckering of lips

2 It has been proven that children who get physical contact while in pain are more comforted. Swaddling is the most appropriate technique to comfort a child. Switching off the lights, leaving the child alone in the room, or playing music will not comfort the child. The child may feel frightened and distressed if such measures are taken. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question

The nurse is caring for a child after a heelstick procedure. What is the best measure to reduce the child's pain and discomfort after the procedure? 1 Switching off all the lights in the child's room 2 Swaddling the child after the procedure is finished 3 Leaving the child alone and allowing relaxation time 4 Playing music in the room and dimming the lights

1, 3 The Synera patch is used to produce analgesic and local anesthetic effects during painful procedures. The patch must be used for only 20-30 minutes to prevent skin irritation. After it is removed from the package, the patch must be applied immediately on the desired site to prevent contamination due to moisture and microbes in the atmosphere. The active ingredients are embedded in the layers of the transdermal patch, so the nurse should not cut or remove the layers of the patch. The patch should never be placed on broken skin because it can irritate the skin surrounding the wound. The holes in the patch should not be covered by a cloth because this will affect absorption of the drug into the skin.

The nurse is caring for a child with severe pain and injuries due to an accident. The primary health care provider has prescribed lidocaine-tetracaine (Synera) transdermal patch to relieve pain. Which steps does the nurse follow while applying the patch to the child? Select all that apply. 1 Applies the patch for a duration of 20-30 minutes 2 Cuts and removes the layers of the patch before applying 3 Immediately applies the patch after opening the package 4 Ensures that the patch is placed on broken skin 5 Ensures that the pores (holes) on the patch are covered by a cloth

2 Ketamine is an anesthetic that is given to patients who have pain due to severe burns. It can cause dysphoria, which is associated with anxiety. Therefore, to prevent dysphoria, the patient must be pretreated with benzodiazepines such as diazepam, which has anxiolytic activity. Urticaria is characterized by skin rashes, and anxiolytic medications such as diazepam do not treat skin rashes. Diazepam does not prevent hepatotoxicity. Diazepam can cause respiratory depression, because it depresses the central nervous system.

The nurse is caring for a patient with severe burns. The primary health care provider advises the nurse to administer diazepam (Valium) before administering ketamine (Anesket) to the patient. Why does the primary health care provider give this advice to the nurse? To prevent: 1 urticaria 2 dysphoria 3 hepatotoxicity 4 respiratory depression

2 Opioid medications are found to be effective in managing postoperative pain. Fentanyl is an opioid drug effective both as an anesthetic during surgery and as a sedative in pain management. Tolmetin, naproxen, and acetaminophen are nonopioid sedatives for pain management. They are used for managing pain in mild to moderate conditions and not used for managing severe pain such as postoperative pain.

The nurse is caring for a postoperative child. On assessment, the child rated the level of pain as 8. Which drug should be administered to manage the child's pain? 1 Tolmetin (Tolectin) 2 Fentanyl (Sublimaze) 3 Naproxen (Naprosyn) 4 Acetaminophen (Tylenol)

4 Children with chronic illnesses are more likely to identify invasive procedures as stressful compared with children with acute illnesses. There are no data to support the theory that children tolerate pain better than adults. The child has increasing difficulty with numerous and repeated painful procedures rather than becoming accustomed to them. Pain is whatever the experiencing person defines it to be.

The nurse is starting an intravenous (IV) line on a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on the knowledge that: 1 children tolerate pain better than adults. 2 children become accustomed to painful procedures. 3 children often lie about experiencing pain. 4 children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

3 The Bieri Faces Pain Scale has six faces to measure pain in a child, but the scale does not contain a smiling face, which indicates happiness, and a teary face, which indicates worst pain. The Poker Chip Tool is a pain assessment tool in which poker chips are given to the child to measure the pain. The Wong-Baker FACES Pain scale has six faces. The smiling face symbolizes lack of pain, and a teary face indicates intense pain. The Face Pain-Rating Scale for pain assessment in children also contains six faces, including the smiling face and teary face. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.

The nurse is using a pain scale that has six faces indicating increasing degrees of pain severity, but it does not have a smiling face or a face with tears. Which scale is the nurse using? 1 Poker Chip Tool 2 Wong-Baker FACES Pain Scale 3 Bieri Faces Pain Scale 4 Faces Pain-Rating Scale

1 Placebos should never be given by any route in the assessment or management of pain. Placebos should never be given as a means to determine whether pain is real. Individuals respond differently to placebos; thus the patient's response may not be an accurate measure of pain. Response to a placebo is not a measure of the origin of pain and should never be used as a means of assessing pain.

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference, a nurse suggests that they consider administering a placebo instead of the usual pain medication. This decision should be based on knowledge that: 1 this practice is unjustified and unethical. 2 this practice is effective in determining whether a child's pain is real. 3 the absence of a response to a placebo means the child's pain has an organic basis. 4 a positive response to a placebo will not occur if the child's pain has an organic basis.

3, 4 Developmental characteristics of the adolescent's response to pain include: less vocal protest; less motor activity; more verbal expressions (such as "It hurts" or "You're hurting me"), and increased muscle tension and body control. Stating, "You're hurting me" and muscle tension are expected responses to pain for the adolescent.

When changing a dressing on the leg of a 16-year-old patient who suffered second degree burn injuries, which characteristics of pain expression does the nurse expects to observe? Select all that apply. 1 Stomping feet on the ground and screaming, "No!" 2 Attempting to move leg out of reach of the nurse. 3 Repeatedly stating, "You're hurting me." 4 Clinching fists and tensing arms in anticipation. 5 Scooting away and asking parents to stop the nurse.

2, 4, 5 The numeric scale is a pain assessment method that uses a straight line with divisions marked as scores, with one end written as "No Pain" and the other as "Worst Pain." The child is asked to point at the divisions, and the pain is scored accordingly. The visual analog scale also uses a straight line where the divisions are marked as scores. One end of the scale is marked "No Pain" and other as "Worst Pain." The word-graphic rating scale uses descriptive words marked on the line to denote varying intensities of pain. The FLACC scale involves observing and rating the behavioral patterns of the child. The color tool scale uses markers for a child to create his or her own scale by representing the pain experienced using different colors.

Which assessment scales rate pain using the straight line method? Select all that apply. 1 Face, Legs, Activity, Cry, Consolability (FLACC) scale 2 Numeric scale 3 Color tool scale 4 Visual analog scale 5 Word-graphic rating scale

1 Common metric systems such as a 0-10 numerical scale are used to assess pain in children. It helps the nurse determine the severity of pain and thus provide effective treatment. Traditional methods may not provide immediate pain relief and may cause drug interactions. Therefore, a customized treatment plan is needed. Pain assessment questionnaires should be used to assess the pain. Morphine (Avinza) can be administered for pain relief to a child with severe pain.

Which nursing action should be implemented to provide effective pain relief in an 11-year-old child with severe pain? 1 using a 0-10 numerical scale for assessment 2 encouraging the use of traditional pain-relieving methods 3 avoiding the use of pain questionnaires for assessment 4 avoiding administering morphine (Avinza) to child

4 The Adolescent Pediatric Pain Tool allows the child to describe the pain by using a list of 56 words. The words in the list are clustered according to sensory, affective, and evaluative qualities of pain. The Color Tool is a pain assessment tool in which a child's pain is rated by using colors. The Poker Chip Tool helps assess pain by using poker chips, not a word list. The COMFORT scale is used to assess pain in an unconscious and ventilated patient in a critical care unit. This is an unobtrusive method in which pain is assessed by observing the patient. Test-Taking Tip: Calm yourself by closing your eyes, putting down your pencil (or computer mouse), and relaxing. Deep-breathe for a few minutes (or as needed, if you feel especially tense) to relax your body and to relieve tension.

While assessing a child for pain, the nurse asks the child to describe the pain using a list containing 56 words. Which pain tool is the nurse using? 1 Color Tool 2 Poker Chip Tool 3 COMFORT scale pain tool 4 Adolescent Pediatric Pain Tool