Chapter 14 PREP U
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."
Morphine give Intravenous injection
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?
the use of conscious sedation for the lumbar puncture
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?
PCA by proxy
A 14-year-old client is postoperative for scoliosis rod surgery. Upon entering the room, the nurse observes the 3-year-old sibling with the patient-controlled anesthesia (PCA) button in the hand, pressing the button multiple times. The client and the parent are both asleep. What is the correct term for this action?
conscious sedation
A 4-year-old child is scheduled for a magnetic resonance imaging of the skull following a bicycle accident. Which medication would the nurse administer to keep the child still during this procedure?
Conscious sedation
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?
Capillaries dilate and edema reduces to the lower extremity
A client comes to the clinic following an ankle injury. The nurse anticipates which therapeutic effect of heat if applied to injury site?
incomplete nerve myelination
A new nurse is orienting to the newborn nursery and asks the nurse mentor why newborns were not considered to experience pain. How does the mentor explain the rationale used in the past that infants do not experience pain?
intramuscular -Oral, intranasal, and intravenous are more acceptable in children.
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?
Tolerance to the medication is beginning to take effect.
After receiving pain medication for 7 days, the client has begun to request pain medication more frequently. What inference about this occurrence is most credible?
The child may be concerned about getting a "shot" and is avoiding the display of pain behaviors. The 11-year-old is using the DVD to withdraw from the discomfort and is lying still to avoid movement, which exacerbates his pain.
An 11-year-old boy is lying quietly in bed watching a DVD on the first postoperative day following open reduction of an ankle fracture. One nurse concludes the child does not need the PRN pain medication; another nurse disagrees. Which of the possibilities described is likely to be true? Select all that apply.
"sports injuries can be very painful. reducing the pain can help with the healing process."
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?
hydromorphone
An adolescent is experiencing severe pain due to a sickle cell crisis. Which medication would be best for the nurse to administer?
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.
Between 1:15 p.m. and 1:45 p.m.
Parents are to bring their kindergarten child to the outpatient department for a venous blood sample. They have EMLA cream to apply at home prior to the procedure and have been shown two areas on the child's arms where they should place the cream. Transportation time is 15 minutes. Their appointment is for 2:45 p.m. At what time should the parents apply the cream and occlusive dressings to both arms?
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.
Riley Infant Pain Scale (RIPS) -maximum score that can be obtained is 18.
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?
Teach the parents the use of the pump and have them push the button to administer additional medication when needed. Administer bolus doses using the PCA pump (push the button) when assessment indicates the need. Assess and document the child's need for pain medication every 1 to 2 hours.
The health care provider has prescribed patient-controlled analgesia (PCA) for a 12-year-old child who just underwent an appendectomy. The nurse has provided education to the child and parents. Which response(s) by the child indicate the need for further instruction? Select all that apply.
"Please tell me and the other nurses when you believe he is in pain."
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:
anesthetic cream
The neonatal nurse is assisting the health care provider with a circumcision. Which pain relief method would be most beneficial?
"I'm not sure if I am imagining it, but I think my child seems to be in less pain when I rock her." "My child seems to cry a lot less with medical procedures if we are reading a book together." "One of the nurses blows bubbles with our child every time she is preparing to perform a procedure, then allows our child to do the same during the procedure. It really helps." "I try to remind our child to think about our dog at home. Our dog is like a big cuddle toy to our child." NOT: "Pain medications are more effective than nonpharmacologic methods for postoperative pain."
The nurse has provided teaching of nonpharmacologic pain management to the parents of a 3-year-old child experiencing postoperative pain. Which comments by the parents indicate that the teaching was effective? Select all that apply.
quivering chin and clenched jaw
The nurse is assessing a newborn thought to be in pain. The nurse uses the FLACC scale to assess a pain level. Which assessment indicates the most pain in the newborn?
administering medication to manage reports of pain is not going to cause addiction
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?
Ensure naloxone is readily available.
The nurse is assisting with the administration of the child's initial dose of parenteral opioids. Which action should the nurse take first?
Developmental age of child
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?
Close the door to the client's room, dim the lights, and close the curtains before beginning.
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?
Face, Leg, Activity, Cry and Consolability (FLACC)
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?
uses words for pain such as owie, boo-boo, or hurt
The nurse is caring for a 2-year-old postoperative PET client. Which consideration is the most appropriate for this child's developmental stage?
Sit with the child and use distractions such as toys during the infusion
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?
Apply an ice pack to the site. Elevate the extremity on a pillow. NOT: Soak the foot in warm water. NOT: Gently massage the area. NOT: Perform acupressure to the area.
The nurse is caring for a 7-year-old child who injured the left foot in a bicycle accident. Upon assessment the nurse notes edema of the left foot. The child states the area has mild pain. Which nursing intervention(s) will the nurse include in the child's plan of care? Select all that apply.
Contact the health care provider and request an opioid pain medication.
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?
"We should start the method after he feels pain."
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?
Alternate these medications around the clock to diminish peaks and valleys in pain control.
The nurse is caring for a burn client with orders for oral ibuprofen and morphine PRN to control pain. Which nursing interaction is the most beneficial for the nurse to implement for pain management?
naloxone
The nurse is caring for a child receiving an epidural opioid medication. The nurse will ensure which medication is readily available for this client?
the child was fretful and grimacing -2 indicates the child is in distress -1 the child is sad or withdrawn -0 child is resting and displaying no obvious signs of discomfort
The nurse is reviewing the documentation from a previous shift concerning the client's scoring on the FLACC scale. The score concerning the assessment of the child's face reports a score of "2". What can be inferred by this?
"During exercise we should wait to check blood sugars until after our child completes the activity."
The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching?
Opioids can be safely used with children
The nurse is teaching the parents about children and pain. Which statement indicates understanding of this teaching?
Requires concentration of the child
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?
Have child keep a diary of when pain occurs
The nurse is working with the parents of a school-age child who has juvenile arthritis. What is the most beneficial method for helping this child assess chronic but intermittent pain?
provide nonnutritive sucking with sucrose
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?
CRIES
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?
Apply it at least 1 hour before the procedure.
The nurse plans to apply a cream with lidocaine and prilocaine to decrease the pain of an injection. What would be the best technique?
Oucher pain rating scale
The nurse realizes that many factors influence a child's pain experience. Which pain scale is appropriate to use with a 5-year-old child?
Have the child blow bubbles
The nurse wishes to use a distraction technique when administering an injection to an anxious child. Which technique would be best for the nurse to implement?
"It is hard to know for sure, but research shows that it is possible for newborns to experience pain."
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?
Pain assessment needs to be done on a regular basis
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?
sleep disturbances, exhaustion, irritability, mood disturbances, and depression
What are some negative effects that chronic pain can have on the pediatric population?
Reflex withdrawal to stimulus and facial grimacing
What behavioral responses to pain would a nurse observe from an infant younger than age 1?
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.
What scenario demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric clients?
The nurse can visualize a blanching effect
When assessing a wound for proper anesthetic effect, which finding would indicate the wound would be ready for suturing?
Apply EMLA cream to two possible insertion sites and wait at least 10 minutes before attempting.
When preparing to perform an IV insertion, what is the most important nursing intervention?
"I should give my toddler one baby aspirin."
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?
inability to be consoled
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?
"Familiarity with procedures lessens the pain experienced."
A nursing instructor teaching students about pain control in children realizes a need for further instruction when a student states:
"Focus on a story during the blood draw."
A parent expresses concern about a 3-year-old child's pain while having blood drawn and asks the nurse what she can do to help the child. Which response by the nurse will be most beneficial?
pain threshold
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:
"This medication should be taken on an empty stomach."
The nurse is caring for a 17-year-old child who has sprained her ankle. The physician has prescribed ibuprofen to manage the pain. What statement by the adolescent indicates the need for further instruction?
Visceral
A 5-year-old arrives at the emergency department and reports abdominal pain. After performing an assessment and laboratory work, the health care provider diagnoses appendicitis. The nurse knows that this child is experiencing which type of pain?
visceral
A 5-year-old arrives at the emergency department and reports abdominal pain. After performing an assessment and laboratory work, the health care provider diagnoses appendicitis. The nurse knows that this child is experiencing which type of pain?
Have the parent sing softly to the child during the procedure.
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?
The child received an injection during the previous visit to the emergency room.
A 6-year-old child has a fractured left leg and has been crying. The child denies having any pain while continuing to lie still without movement of the extremity. What would the nurse suspect as the reason for this behavior?
Acute referred pain
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
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:
"Imagine that you are swimming in a cool, shady pool where nothing can harm you."
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?
Apply cold packs to the ankle for the first 24 hours
A child has been seen by the healthcare provider following a skateboard accident. The child has a sprained ankle and is being sent home to rest. Which nursing instructions will be most helpful to reduce the swelling?
topical lidocaine cream
A child is getting ready to have a lumbar puncture. The nurse recognizes which medication prescription is best to reduce the pain for this procedure?
"The underlying principle of distraction is focusing on stimuli other than the pain being experienced." "Some people may find singing or counting a good form of distraction." "Using media such as TV or movies can be a distraction technique."
A child is in treatment for cancer and has been experiencing pain. The nurse is talking with the parents about assisting with pain management using distraction. Which statement(s) indicates an understanding of the information provided? Select all that apply.
"The underlying principle of distraction is focusing on stimuli other than the pain being experienced." "Using media such as TV or movies can be a distraction technique." "Some people may find singing or counting a good form of distraction."
A child is in treatment for cancer and has been experiencing pain. The nurse is talking with the parents about assisting with pain management using distraction. Which statement(s) indicates an understanding of the information provided? Select all that apply.
poker chip tool FACES pain rating scale
A child with Down syndrome has had surgery and experiences periodic pain. The child is 13 years old but functions much like an 8-year-old. Which pain scales may be appropriate for pain assessment? Select all that apply.
Infants less than 12 months of age receiving methemoglobin-inducing agents
A nurse is applying EMLA (lidocaine 2.5% and prilocaine 2.5%) as ordered. The nurse understands that EMLA is contraindicated in which situation?
decreased heart rate
A nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain?
Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen.
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?
fearing getting a "shot" to relieve the pain
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?
Be careful not to let your son remove the dressing, as the cream can cause damage to his eyes if he rubs them.
A nurse is instructing the parents of a toddler on the use of an anesthetic cream in advance of an upcoming procedure the child will have. What information should the nurse mention to them?
Numerical
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?
numerical
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?
Somatic
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?
Face, leg, activity, cry, and consolability (FLACC) descriptors
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?
"You might experience decreased sensation and ability to move your legs while using this route of medication."
The nurse is caring for a 15-year-old adolescent receiving patient-controlled analgesia (PCA) via an epidural for pain in the extremities due to bilateral compound leg fractures. Which statement is correct when teaching this adolescent about using this device?
The child's nonverbal behaviors may indicate the presence of discomfort.
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?
"Meperidine is associated with toxicity issues in children and is usually avoided." -toxicity on the CNS
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?
Visceral
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?
"I understand why you think your child is not in pain; sleep is often a way for children to cope with pain."
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?
Acetaminophen
The nurse is caring for a pediatric client experiencing mild to moderate pain related to a recent bone marrow biopsy procedure. The child is receiving chemotherapy treatments for a cancer diagnosis. The child has several p.r.n. pain medication options on the medication administration record. Which medication should the nurse administer?
Monitor the clients respiratory rate.
The nurse is caring for a pediatric client following an open appendectomy. The client rates the pain an "8" on a 0 to 10 pain scale and the nurse administers morphine sulfate intravenously to the client per the primary health care provider's prescription. Which nursing action is priority following administration of the medication?
Educate the parents about the need for pain relief in proper doses
The nurse is caring for a school-age child who had an appendectomy the day before. The parents express concern about the use of pain medications. Which is the best nursing response?
The newborn's pain pathway components are developed enough at birth to experience pain.
The nurse is caring for a term neonate suffering from meconium aspiration in the nursery. The nurse reviews orders for a peripherally inserted central catheter (PICC) line placement and intubation. Which statement demonstrates the nurse's knowledge of painful procedures as related to a neonate?
Experiences with pain even in infancy can influence an individual's response to pain later.
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?
Anticipate when pain will occur and plan interventions to prevent it.
The nurse is caring for children on a postoperative unit. Which nursing action promotes the most efficient pain control?
Pain medication should be given on a routine basis.
The nurse is planning immediate postoperative care for an infant after repair of a cleft lip. What should the plan include?
Pain meds should be given on a routine basis
The nurse is planning immediate postoperative care for an infant after repair of a cleft lip. What should the plan include?
"Pick your favorite Band-Aid and show me which arm to use."
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?
postsurgical 6-year-old child who is unable to accurately report pain level
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?
"This can be taken with other medications we have at home that didn't require a prescription."
The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching?
Give the mother the FACES pain rating scale to use with her son.
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?
Client will have a soft, formed bowel movement daily
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?
The child is using the scale to predict what they would like, not what the child has.
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?
no hurt no owie no boo-boo
The nurse wishes to reassure a 3-year-old girl that there will be no discomfort when her peripheral IV site is examined. The nurse will use which words? Select all that apply.
have the child blow bubbles
The nurse wishes to use a distraction technique when administering an injection to an anxious child. Which technique would be best for the nurse to implement?
Gently massaging a preterm infant's leg for 2 minutes prior to obtaining a blood sample from a heel stick.
Which nursing intervention demonstrates proper use of cutaneous stimulation to relieve pain in pediatric clients?
