Chapter 14: Pain Management in Children Practice Q"s

The nurse is assigned to care for a 14-year-old child who is hospitalized in traction for serious leg fractures after an automobile accident. The parents ask the nurse to avoid administering analgesics to their child to help prevent him from becoming addicted. Which response by the nurse is indicated? "Your child is too young to experience drug addiction." "If there is no history of substance use disorder in the family there should be no increased risk for the development of addiction." "Administering medications to manage reports of pain is not going to cause addiction." "We can talk with the health care provider to see about reducing the amount of medications given to reduce the potential for addiction."

"Administering medications to manage reports of pain is not going to cause addiction." Responsible nursing care requires the nurse administer pain medication as needed. The nurse has the authority to discuss the child's pain control needs with the parents. There is no need to discuss the reduction of medications with the health care provider. Family history of substance use disorder is not a factor in the care of this child. Young children can become addicted to analgesics. There is, however, no indication that addiction is a valid concern with this child.

The experienced nurse is providing shift handoff to a graduate nurse. Which statement of pain management by the graduate nurse requires clarification by the expert nurse? "There is no more danger of respiratory depression in children than in adults." "Opiates can be given to children without untoward effects." "Adults as well as children can suffer from respiratory depression if given too much morphine." "Children should not be given morphine, because they are at risk for respiratory depression."

"Children should not be given morphine, because they are at risk for respiratory depression." all the statements are true except for the one stating that children should not be given morphine because of a danger of respiratory depression. If the dosage of an opiate is based on the child's size, then there is no more danger of respiratory depression in children than in adults. Morphine is the most common pain medication for children with moderate to severe pain.

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 do not have to give my toddler pain medication unless it is needed." "Use of infant acetaminophen is good for my toddler." "Ibuprofen can be purchased over the counter to use if my toddler needs it." "I should give my toddler one baby aspirin."

"I should give my toddler one baby aspirin." Children, including toddlers, should not use acetylsalicylic acid for routine pain management or to treat fever because of the increased risk of Reye syndrome. The use of the other options is appropriate and all statements indicate an understanding of pain management for this child.

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? "I understand why you are nervous. I will see if there is another option." "This is a quick procedure that will not hurt much at all." "Imagine that you are swimming in a cool, shady pool where nothing can harm you." "Think happy thoughts and everything will be okay, I promise."

"Imagine that you are swimming in a cool, shady pool where nothing can harm you." Using guided imagery is the best response by the nurse to help calm the child. Because children have keen imaginations, they are able to substitute a pleasant thought for an unpleasant one. Telling the child "everything will be okay" and "will not hurt much" are not therapeutic and are subjective. Stating the nurse will see about other options is inappropriate.

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." "Your newborn's nervous system is not developed enough to experience pain." "Although it is possible for your newborn to experience pain, it is very unlikely for the pain to be intense." "I am sure your newborn is too young to experience any pain."

"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? "I can certainly contact the surgeon about prescribing this medication for your child." "Meperidine often causes severe nausea, vomiting and diarrhea in children and its use should be limited." "Meperidine is associated with toxicity issues in children and is usually avoided." "Since this medication worked for you it may indeed be of benefit to your child

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

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: "We will check every 4 hours to see if he needs the pain medicine." "He looks comfortable to me and was sleeping each time I checked. The medication given earlier seems adequate." "This is the medication he gets every 4 to 6 hours. It will control his pain for that period of time." "His vital signs are stable, telling me he must be comfortable." "Please tell me and all of the nurses when you believe he is in pain."

"Please tell me and all of the nurses when you believe he is in pain." Having the mother share her assessments is very helpful. She knows the child the best. The statements about the medication and checking every 4 hours may be true but do not acknowledge the mother and the importance of her input. Looking comfortable (stillness) and even sleeping can be a coping strategy used by the child. Stable vital signs can be misleading. (Continually elevated signs can be interpreted as stable.) Many events can raise vital signs, including anxiety or happy excitement. Physiologic signs should be interpreted with care and combined with behavioral signs of pain.

An adolescent has been injured while playing sports. The adolescent describes only minimal pain but the nurse observes clenched fists, rapid breathing and increased muscle tension. Which approach would be best to offer this adolescent pain medication? "When you feel you would like a dose of pain medication, I will administer it." "Sports injuries can be very painful. Reducing the pain can help in the healing process." "Here is a dose of pain medication so you can be better relaxed while your injury is treated." "Pain medication is available for you. Do you want a dose at this time?"

"Sports injuries can be very painful. Reducing the pain can help in the healing process." Adolescents have problems with accepting pain because of body image concerns and fear of losing control. They fear their behavior will make them look juvenile and thus try to remain stoic and not exhibit emotion. The nurse should address these concerns by being very matter-of-fact and truthful. The nurse can validate the adolescent's pain by stating the injury will cause pain. Explaining that reduction in pain can help in healing is a positive way to offer the pain medication and not make the adolescent appear to lose control. Telling the adolescent pain medication is available or that the adolescent should ask for medication can prolong the pain as the adolescent may be embarrassed to ask because of not wanting to risk being seen as weak or childish. Pain medication should be administered for pain, not as a relaxing agent to be used for treatment.

A client comes to the clinic following an ankle injury. The nurse anticipates which therapeutic effect of heat if applied to injury site? Edema is noted around the injury site. Blood flow decreases to the area and the skin is pale. Redness increases and slowly extends up the leg. Capillaries dilate and edema reduces to the lower extremity.

Capillaries dilate and edema reduces to the lower extremity.

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 voice no difficulty with bowel movements. Client will have a soft, formed bowel movement daily. Client will have a bowel movement without difficulty. Client will not be constipated during the stay in the facility.

Client will have a soft, formed bowel movement daily. Since the client's normal bowel pattern is daily, the most measurable goal describes the characteristics of normal stools on a daily basis. The other options are not measurable, making it impossible to measure during the evaluation phase of the nursing process.

The nurse is assisting with the administration of the child's initial dose of parenteral opioids. Which action should the nurse take first? Premedicate with acetaminophen. Assess for any adverse reaction. Ensure naloxone is readily available. Assess the status of bowel sounds.

Ensure naloxone is readily available.

The nurse wishes to use a distraction technique when administering an injection to an anxious school-aged child. Which technique should the nurse implement? Have the child practice controlled deep breathing. Have the child create a mental image of something pleasant. Have the child repeat a pleasant thought out loud. Have the child blow bubbles.

Have the child blow bubbles. Behavioral-cognitive strategies are useful for pain management in many ways and forms. They involve measures requiring the child to focus on a specific area rather than the pain. A distraction technique helps the child focus on another stimulus. Examples of this are counting, saying ouch, blowing bubbles, and music. Having a child create a mental image of something pleasant is a form of imagery. Using controlled deep breathing is a form of relaxation. Teaching the child to make positive statements such as "it will be over soon" is a form of thought stopping.

The nurse is teaching the parents about children and pain. Which statement indicates understanding of this teaching? Infants do not experience pain. Sleeping children cannot be in pain. Believe a child who says he or she is not in pain. Opioids can be safely used with children.

Opioids can be safely used with children.

The nurse needs to heel stick a premature infant to obtain blood for laboratory samples. Which technique would the nurse utilize to provide the most pain relief? Have another nurse hold the infant for comfort. Provide nonnutritive sucking with sucrose. Swaddle the infant tightly. Administer a low dose of pain medication.

Provide nonnutritive sucking with sucrose. Preterm infants feel pain, and they feel it with greater intensity. Sucking is a behavior from which the infant gets satisfaction. Nonnutritive sucking, such as a pacifier, provides comfort and helps reduce pain. It has been found that using sucrose with nonnutritive sucking decreases the amount of pain and pain behaviors in the preterm infant. Swaddling the infant and having someone hold the infant provides comfort but does not reduce the pain as well as sucrose and nonnutritive sucking. It would be contraindicated to administer a pain medication prior to a heel stick, even at a low dose. The risks would outweigh the benefits.

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. Ensuring the lighting is adequate for the procedure but not so bright to cause discomfort. Conducting a baseline physical assessment. Ensuring that emergency equipment is readily available.

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

When assessing a wound for proper anesthetic effect, which finding would indicate the wound would be ready for suturing? The nurse can visualize a darkened appearance. The nurse can visualize fresh bleeding. The nurse can visualize a blue tone. The nurse can visualize a blanching effect.

The nurse can visualize a blanching effect. When assessing readiness of an anesthetic agent, the nurse should assess for a change in the skin color. This is either blanching or redness. A blue or darkened color would not indicate the effectiveness of the local anesthetic and may indicate a complication that should be assessed. If the wound requires suturing, fresh bleeding may continue to occur even though the surrounding skin is anesthetized. A local anesthetic will control pain, not bleeding.

The neonatal nurse is assisting the health care provider with a circumcision. Which pain relief method would be most beneficial? nonsteroidal anti-inflammatory drugs glucose on a pacifier anesthetic cream morphine drops

anesthetic cream Anesthetic cream can be used effectively for pain relief with circumcision. It is a short procedure; therefore, morphine by mouth is not needed as it takes longer to wear off and has more side effects. Glucose on a pacifier may help but not as much as the anesthetic cream. NSAIDS would be beneficial after the procedure for pain relief but not during the procedure.

Question 10 of 10 A new nurse is preparing to administer pain medication to a child on the pediatric unit. Which method of pain medication administration used by the new nurse would require the nurse manager to intervene? intranasal intravenous oral intramuscular

intramuscular As a rule, intramuscularly administered analgesia should be avoided in children because children dislike injections and have a limited number of adequate injection sites. Oral, intranasal, and intravenous are more acceptable in children.

A nurse is working on a pediatric postoperative unit. Which pain assessment method is best for the nurse to use with an adolescent to determine severity of pain? description of pain Wong-Baker FACES scale FLACC scale numerical

numerical Adolescents are able to use adult numerical pain scales for assessment of pain severity. FLACC scale is used with infants and Wong-Baker FACES scale is used with younger children. A description does not address pain severity.