NUR 236 PrepU Chapter 36: Pain Management in Children

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

fearing getting a "shot" to relieve the pain

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

visceral

The 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?

"Children should not be given morphine, because they are at risk for respiratory depression."

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?

"Focus on a story during the blood draw."

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

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

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

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

The parent of a child with periorbital cellulitis comes to the nurses' station and asks to speak with the nurse. The parent states, "The oral pain medication you gave my child 45 minutes ago is not working!" What is the nurse's best response?

"Oral medications take about 45 minutes to start working. I will be back in 20 minutes to check the pain level again."

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

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

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

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

A nurse is interviewing the mother of a sleeping 10-year-old girl to assess the level of the child's postoperative pain. Which comment should trigger additional questions and necessitate further teaching?

"She is asleep, so she must not be in 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?

"Sports injuries can be very painful. Reducing the pain can help in the healing process."

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

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

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

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

The nurse is 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?

"This medication should be taken on an empty stomach."

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

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

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

Acute referred pain

The 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.

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

CRIES

The nurse is 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?

Educate the parents about the need for pain relief in proper doses.

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

Ensure naloxone is readily available.

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

Fear related to anticipation of painful procedure

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

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

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

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

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

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

A parent expresses concern to the nurse that her 18-month-old child might have an ear infection. Which symptom would alert the nurse that this is a possibility?

The child is pulling on the ear.

The nurse is working with a 5-year-old boy who must receive repeated intravenous injections as part of his treatment. He hates the injections, however, and is frightened whenever he sees the syringe and needle. In an attempt to overcome this fear, the nurse holds the syringe up for him to see and tells him, "This looks kind of like a space rocket, don't you think? Here comes the space rocket—it needs to refuel." Which pain management technique is the nurse using here?

Imagery

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

Numeric pain intensity scale

The nurse is caring for a 5-year-old child who underwent a painful surgical procedure earlier in the day. The nurse notes the child has not reported pain to any of the nursing staff. Which action by the nurse is indicated?

Observe for behavioral cues consistent with pain.

The nurse is about to assess pain in the child and will use the QUESTT acronym as a guide to objective and subjective data collection. This acronym stands for what? Select all that apply.

Question the child. Take action.

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.

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.

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

Somatic

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

The child may be in pain.

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

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

A 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

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

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

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

decreased heart rate

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

hydromorphone

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

morphine

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

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

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

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

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?

topical lidocaine cream

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

with meals