Pediatric Ch. 5

The nurse is preparing an 8-year-old child for a subcutaneous injection. Which statement by the nurse is most effective?

"It may feel like pinching. You tell me how it feels."

The nurse is assessing a 10-year-old child with recurrent headaches. Which questions does the nurse ask the parents in order to analyze the cause of the headaches? Select all that apply.

"Tell me about your child's school-related work." "What kind of medications is your child taking?" "When was the last time your child visited an ophthalmologist?" "How often does your child complain of headache?"

A child who weighs 30 kg (66 lb) was prescribed choline magnesium trisalicylate. The safe dose of the drug is 30mg/kg/day, divided into two doses. What is the prescribed dosage of the drug for effective pain management?

450 mg

An infant of 5 months has mild grimacing, restless leg movements, and an increased activity level with rigid body. The infant is difficult to console and cries steadily but weakly. What is the FLACC score of the infant? Record your answer using a whole number.

7.

What method of analgesia delivers a constant amount of analgesic and prevents pain from returning?

Continuous basal rate infusion

The nurse is using a pain scale for a nonverbal child. What behavior would be assessed in the limb subscale?

Is the child flinching?

What are some of the most common side effects of opioid analgesics? Select all that apply.

Sedation Constipation Nausea and vomiting Respiratory depression

What category of medications can be used alone or in combination with opioids to control pain symptoms?

Adjuvant analgesics

Transdermal fentanyl is being used for an adolescent with cancer who is in hospice care. The adolescent has been comfortable for several hours but now complains of severe pain. What is the most appropriate nursing action?

Administering morphine sulfate immediate release (MSIR) intravenously

A nurse is caring for a 5-year-old child who has a new order for the insertion of an intravenous line. What intervention will be the most effective way of providing analgesia before this procedure?

Applying LMX (4% liposomal lidocaine cream) 30 minutes before the procedure

The nurse is caring for a neonate under intensive care. What would be the first signs of pain in the neonate? Select all that apply.

Changes in facial expression Changes in activity Changes in consolability

A nurse is starting an intravenous (IV) line for a school-aged child with cancer. The child says, "I've had a million IVs. They hurt." The nurse's response should be based on which statement?

Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

In which way is chronic pain in children differentiated from recurrent pain?

Chronic pain persists for 3 months or more.

The nurse is preparing to give an intramuscular injection to a child. Which nursing intervention would work best to decrease the amount of pain?

Diluting the medication with lidocaine before administering the injection

The nurse is teaching a group of children about strategies of pain management. Which teaching strategy does the nurse use to educate the children?

Educate using interactive audio visual aids.

While caring for a neonate who has received multiple intramuscular vaccines, the nurse anticipates that the neonate is experiencing acute pain. Which findings support the nurse's conclusion? Select all that apply.

Excessive perspiration Increased blood pressure Fist clenching and thrashing

The nurse is assessing a 4-year-old child for intensity of pain after administering an injection. What does the nurse use for this purpose?

Faces pain scales

The nurse should recognize that children with unrelieved severe pain may engage in certain behaviors. What behaviors should the nurse expect to encounter in a child experiencing severe unrelieved pain?

Frequent checking of the clock

A child who has been receiving morphine by way of the intravenous (IV) route will now start receiving it orally. For equianalgesia (equal analgesic effect) to be achieved, what must the oral dose be?

Greater than the IV dose

A child indicates "worst possible pain" on the Word-Graphic Rating Scale. What medication is most appropriate to be ordered for the child as a substitute for morphine?

Hydromorphone

A child with severe cognitive impairment may express ineffectively managed pain with which responses? Select all that apply.

Inconsistent patterns of play Moaning Spasticity Flinching

A child who is treated with morphine for cancer-related pain develops tolerance to the drug. Which intervention is performed to treat tolerance in the child?

Increase the dose of the drug.

The nurse is assessing pain in a 3-month-old infant. Which physiologic signs indicate acute pain in the infant? Select all that apply.

Increased muscle tone Pallor or flushing Rapid, shallow respirations Dilated pupils

After administering an intramuscular injection to a newborn, which physiologic responses related to acute pain might the nurse observe? Select all that apply.

Increased muscle tone Rapid, shallow respirations

The nurse is caring for a child who needs continuous pain control medications. Which medication route for analgesic administration proves to be most effective for the child?

Intravenous

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. The decision should be based on which knowledge?

It is unjustified and unethical to administer placebos instead of pain medication.

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on which knowledge?

Large doses of opioids are justified when there are no other treatment options.

The nurse is assessing pain in a 7-year-old child with cognitive impairment and communication difficulties. Which sign does the nurse observe for pain in the child?

Moaning

A child with a major burn injury needs a dressing change, which is a long procedure. What analgesics are used for this child before the procedure is initiated?

Morphine

While caring for a child receiving morphine, the nurse observes that the child is apneic and cannot be aroused. Which medication does the nurse administer as prescribed to the child?

Naloxone

The nurse is caring for a postoperative child who has congenital vision impairment. Which pain assessment scale does the nurse use for recording the vital signs of the child?

Non-communicating Children's Pain Checklist

The nurse is asked to administer the prescribed dose of an analgesic via the oral route to a 7-year-old child. The nurse observes that the child is unwilling to take the medication orally. The nurse considers obtaining a prescription to change the route to intravenous administration. What is the nurse's first action?

O The nurse asks whether the child can take the medication intravenously.

What is the appropriate action when the route of morphine administration is changed from intravenous to oral?

O The oral morphine dosage must be larger than the intravenous dosage to be effective.

The nurse is teaching a group of nursing students alternate versions of pain assessment scales for children who do not speak English. Which pain assessment scales are available in alternate versions? Select all that apply.

Oucher Pain Scale Adolescent Pediatric Pain Tool

Which self-report pain rating scale can be used with children ages 3 to 13 years?

Oucher scale

A 6-year-old child is hospitalized with a fractured femur. The nurse draws on knowledge of pain assessment tools and child development to select that assessment tools that are most appropriate for this age of child. What they? Select all that apply.

Oucher scale FACES pain scale

The nurse is using the CRIES pain assessment tool on a preterm infant in the neonatal intensive care unit (NICU). What is a component of this tool?

Oxygen saturation

A child is prescribed a buccal analgesic for pain relief. How should the nurse administer the drug to the child?

Place the drug between cheeks and gums.

A nurse is caring for an 8-year-old child who has undergone surgery for multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. What is an important consideration in the management of the child's pain?

Planning a preventive schedule of pain medication around the clock

A nurse is caring for a 7-year-old child who has undergone surgery for severe wounds and multiple fractures sustained in a motor vehicle accident. What is the priority nursing intervention in managing this child's pain?

Planning an around-the-clock schedule of preventive pain medication

What is the best approach in managing pain in children?

Preventing pain

A child is being seen in the emergency department with multiple facial abrasions and lacerations. A combination agent containing lidocaine, adrenaline, and tetracaine (LAT gel) is applied topically to the wounds. What is the purpose of this combination therapy?

Provide anesthesia to the wound

What is the most effective strategy for obtaining postoperative pain control in children?

Providing preemptive analgesia

The nurse is caring for a 12-year-old child who sustained major burns when putting charcoal lighter fluid on a campfire. The nurse notes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action?

Requesting a psychologic consultation

The nurse is caring for a comatose child with multiple injuries. Which statement should the nurse recognize?

Requires astute nursing assessment and management

Which pain scale should the nurse consider using when delivering care to a Spanish-speaking child experiencing acute pain?

Self-report scales

A parent of a 2-month-old infant tells the nurse, "How can I calm my baby after vaccination? My poor baby cries a lot, and I'm unable to stop the baby from crying." What is the nurse's best response?

Swaddling

Which nonpharmacologic interventions will the nurse provide for a preterm infant who requires a heel puncture? Select all that apply.

Swaddling Non-nutritive sucking Kangaroo care

The nurse observes that a 13-year-old child with sickle cell anemia engages in manipulative behavior, is preoccupied with obtaining the opioid, and persistently asks for more analgesic. What can the nurse conclude from this behavior?

The child has developed clock-watching behavior.

The nurse observes that the usual dose of analgesic is unable to relieve pain in a 12-year-old child with sickle cell anemia after 3 weeks. What does the nurse conclude from this finding?

The child has developed tolerance

The nurse observes increased irritability, nausea, diarrhea, sweating, and fever in a child on the second day after discontinuing the opioid dose. What does the nurse conclude from the child's condition?

The child is having withdrawal symptoms.

The nurse is caring for a 5-year-old child after surgery. What is the most appropriate way for the nurse to describe to the parents how a patient-controlled analgesic (PCA) pump works?

The pump permits release of a continuous basal rate of pain medication to deliver constant pain control.

Why are physiologic measurements in the assessment of pain in children not as useful as other measurements of pain?

The same physiologic signs that suggest fear, anxiety, or anger can also indicate pain.

Why are physiologic measurements in the assessment of pain in children not useful as other measurements of pain?

The same physiologic signs that suggest fear, anxiety, or anger can also indicate pain.

Which is an important consideration when the FACES Pain Rating Scale is used with children?

The scale may be used with most children as young as 3 years of age.

What is true about nonpharmacologic strategies for pain management?

They may reduce pain perception.

What is the current understanding for how nonpharmacologic strategies for pain management work in children?

They provide coping strategies that help reduce pain perception.

The nurse is teaching pain management strategies to the parents of a 6-year-old child with recurrent abdominal pain. The nurse instructs the parents to not give excessive attention to the child's abdominal pain. What is the purpose of this advice?

To prevent positive reinforcement of the sick behavior

What should the nurse recognize as the most reliable indicator of pain in school-age children?

Verbal report

A health care practitioner discusses the plan of care for initiating the use of biologically based complementary and alternative medicine (CAM) therapy for a child. Which does the nurse understand this therapy may include? Select all that apply

Vitamins Special diets Herbal supplements

The nurse is caring for a child on opioid medication. For what initial signs of withdrawal does the nurse monitor in the child? Select all that apply.

Yawning Rhinorrhea