PED's Chapter 36-Pain Management in Children

two of the most commonly used agents for conscious sedation are:

- midazolam - fentanyl

For which child would nonopioid analgesics be recommended? A) A child with juvenile arthritis B) A child with end-stage cancer C) A child with a broken arm D) A child with severe postoperative pain

A. Nonopioid analgesics may be used to treat mild to moderate pain, often for conditions such as arthritis; joint, bone, and muscle pain; headache; dental pain; and menstrual pain.

The nurse is providing teaching to the parents of a newborn prior to a heelstick. The nurse is describing the procedure and recommending various methods for the parents to help comfort their baby. Which statement by the parents indicates a need for further teaching? A) "It's better if we are not in the room for this." B) "We can use kangaroo care before and after." C) "We hope you are using a very tiny needle." D) "We can offer him nonnutritive sucking to calm him."

A. Unless contraindicated, the parents should be encouraged to be present before, during, and after the procedure to provide comforting support to the child.

The nurse is caring for a child who is recovering from an appendectomy. What is the appropriate term for the pain this child is experiencing? A) Nociceptive pain B) Neuropathic pain C) Chronic pain D) Superficial somatic pain

A. Nociceptive pain reflects pain due to noxious stimuli that damages normal tissues or has the potential to do so if the pain is prolonged. Nociceptive pain ranges from sharp or burning; to dull, aching, or cramping; to deep aching or sharp stabbing. Examples of conditions that result in nociceptive pain include chemical burns, sunburn, cuts, appendicitis, and bladder distention.

The nurse is preparing to administer a topical anesthetic for a 10-year-old girl with a chin laceration. The nurse would expect to apply what as ordered in preparation for sutures? A) TAC (tetracaine, epinephrine, cocaine) B) Iontophoretic lidocaine C) EMLA D) Vapocoolant spray

A. TAC (tetracaine, epinephrine, cocaine) is commonly used for lacerations that require suturing. The agent can be applied directly to the wound with a cotton ball or swab for 20 to 30 minutes until the area is numb. * EMLA and iontophoretic lidocaine are applied to intact skin, not to open wounds or lacerations.

a nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain? a. decreased oxygen b. decreased HR c. palmar sweating d. plantar sweating

B. heart rate would increase, not decrease

Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain? A) FACES pain rating scale B) Oucher pain rating scale C) Poker chip tool D) Numeric pain intensity scale

D. The numeric pain intensity scale can be used with children as young as 5 years of age, but the preferred minimum age for using this tool is 7 years. .

Naloxone

reverse opioids effect

patient-controlled analgesia is usually given older than ______

seven

The nurse is managing children who have chronic diseases in a neighborhood clinic. What are some examples of chronic conditions? Select all that apply. A) Diabetes mellitus B) Myocardial infarction C) Rheumatoid arthritis D) Compound fracture E) Acute asthma F) Bronchopneumonia

A, C, E Chronic pain is defined as pain that continues past the expected point of healing for injured tissue. Diabetes, arthritis, and asthma are examples of chronic pain. Acute pain is defined as pain that is associated with a rapid onset of varying intensity. It usually indicates tissue damage and resolves with healing of the injury. Examples include heart attack, fractures, and bronchopneumonia.

The nurse is researching behavioral-cognitive pain relief strategies to use on a 5-year-old child with unrelieved pain. Which methods might the nurse choose? Select all that apply. A) Relaxation B) Distraction C) Thought stopping D) Massage E) Sucking

A,B,C Common behavioral-cognitive strategies include relaxation, distraction, imagery, thought stopping, and positive self-talk. - Sucking and massage are examples of biophysical interventions.

The nurse is researching behavioral-cognitive pain relief strategies to use on a 5-year-old child with unrelieved pain. Which of the following methods might the nurse choose? Select all answers that apply. A) Relaxation B) Distraction C) Biofeedback D) Thought stopping E) Massage F) Sucking

A,B,C,D

___________ pain is pain due to malfunctioning of the peripheral or central nervous system.

Neuropathic

__________ analgesics are typically used for moderate to severe pain as can occur with cancer, broken bones, and postoperative healing.

Opioid

Prior to administering morphine to a 10-year-old child, the nurse reviews the adverse effects of the drug. Which system is primarily affected by the drug, causing most of the adverse effects?

Opioid agonists, such as morphine, are associated with numerous adverse effects, resulting primarily from their depressant action on the central nervous system.

_______________ pain, often called cutaneous pain, involves stimulation of nociceptors in the skin, subcutaneous tissue, or mucous membranes.

Superficial somatic

A child is scheduled for a bone marrow aspiration at 4 PM. The nurse would plan to apply EMLA cream to the intended site at which time?

To ensure the effectiveness of EMLA cream for a bone marrow aspiration, which is considered a deep procedure, the nurse would apply the cream 2 to 3 hours before the time of the procedure. Since the scheduled time is 4 PM, applying the cream between 1 and 2 PM would be appropriate. If the procedure was a superficial procedure such as venipuncture or heelstick, then the nurse would apply the cream 1 hour before the

the "gold satandard" for all opiod agonist and is the drug to which all other opiods are compared

morphine

pain threshold

the point at which an individual feels the lowest intensity of painful stimulus

The nurse caring for infants in the neonatal intensive care unit (NICU) relies on the use of behavioral and physiologic indicators for determining pain. Which examples are behavioral indicators? Select all that apply. A) The infant grimaces. B) The infant's heart rate is elevated. C) The infant flails his arms and legs. D) The infant's respiratory rate is elevated. E) The infant is crying uncontrollably. F) The infant's oxygen saturation is low.

A,C,E In preterm and term newborns, behavioral and physiologic indicators are used for determining pain. Behavioral indicators include facial expression, body movements, and crying. Physiologic indicators include changes in heart rate, respiratory rate, blood pressure, oxygen saturation levels, vagal tone, palmar sweating, and plasma cortisol or catecholamine levels.

The nurse is assessing the pain of a postoperative newborn. The nurse measures the infant's facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. Which behavioral assessment tool is being used by the nurse? A) Riley Infant Pain Scale B) Pain Observation Scale for Young Children C) CRIES Scale for Neonatal Postoperative Pain Assessment D) FLACC Behavioral Scale for Postoperative Pain in Young Children

A. The Riley Infant Pain Scale measures six parameters: facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch.

The student nurse is learning about the effects of heat and cold when used in a pain management plan. What accurately describes one of these effects? A) Cold results in vasodilation. B) Cold alters capillary permeability. C) Heat results in vasoconstriction. D) Heat decreases blood flow to the area.

B. Cold results in vasoconstriction and alters capillary permeability, leading to a decrease in edema at the site of the injury. Heat results in vasodilation and increases blood flow to the area.

An adolescent who is a competitive swimmer comes to the emergency department complaining of localized aching pain in his shoulder. He states, "I've been practicing really hard and long to get myself ready for my meet this weekend." The area is tender to the touch. The nurse determines that the adolescent is most likely experiencing which type of pain? A. Cutaneous pain B. Deep somatic pain C. Visceral pain D. Neuropathic pain

B. The adolescent recently experienced an injury to his shoulder, most likely from overuse due to swimming. His description of a dull ache and evidence of tenderness suggest deep somatic pain, which typically involves the muscles, tendons, joints, fasciae, and bones.

The nurse is teaching the student nurse the phyterm-31siology involved in pain transmission. Which statements accurately describes a physiologic event in the nervous system related to pain transmission? Select all that apply. A) Thermal stimulation may involve the release of mediators, such as histamine, prostaglandins, leukotrienes, or bradykinin. B) When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed to the spinal cord and brain. C) Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. D) Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. E) The point at which the person first feels the highest intensity of the painful stimulus is termed the pain threshold. F) Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain.

B, C, D, F When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed along the peripheral nerves to the spinal cord and brain. Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain. Chemical stimulation may involve the release of mediators, such as histamine, prostaglandins, leukotrienes, or bradykinin. The point at which the person first feels the lowest intensity of the painful stimulus is termed the pain threshold.

The nurse is caring for a child who reports chronic pain. What is the priority nursing assessment? A) How the pain impacts the child's and family's stress level B) The pain's history, onset, intensity, duration, and location C) The child's and parents' feeling of anxiety and depression D) The child's cognitive level and emotional response

B. Assessment of the child's pain is key; it is the priority assessment and is the only answer that focuses on the child's physiologic need.

When the nurse is assessing a child's pain, which is most important? A) Obtaining a pain rating from the child with each assessment B) Using the same tool to assess the child's pain each time C) Documenting the child's pain assessment D) Asking the parents about the child's pain tolerance

B. Although obtaining a pain rating, documenting the assessment, and asking the child's parents about the pain are important, the most important aspect of pain assessment is to use the same tool each time so that appropriate comparisons can be made and effective interventions can be planned and implemented. Consistency allows the most accurate assessment of the child's pain.

The nurse tells a joke to a 12-year-old to distract him from a painful procedure. What pain management technique is the nurse using? A) Relaxation B) Distraction C) Imagery D) Thought stopping

B. Distraction involves having the child focus on another stimulus, thereby attempting to shield him from pain. Humor has been demonstrated to be an effective distracting technique for pain management.

The nurse is explaining the effects of heat application for pain relief. Which effect would the nurse be likely to include? A) Decreased blood flow to the area B) Increased pressure on nociceptive fibers C) Possible release of endogenous opioids D) Altered capillary permeability

B. Heat causes an increase in blood flow. This alters capillary permeability, leading to a reduction in swelling and pressure on nociceptive fibers. Heat also may trigger the release of endogenous opioids, which mediate the pain response.

A nurse is providing teaching to the mother of an adolescent girl about how to manage menstrual pain nonpharmacologically. Which statements by the mother indicates a need for further teaching? A) "I need to help her learn techniques to distract her; card games, for example." B) "I need to be able to identify the subtle ways she shows pain." C) "I need to follow these instructions exactly for them to work properly." D) "I need to encourage her to practice and utilize these techniques."

C The mother does not need to follow the instructions exactly; she needs to review the methods and modify them in a way that works best for her daughter. The other statements are correct.

The nurse is administering pain medication for a child with continuous pain from internal injuries. Which method would be ordered to dispense the medication? A) Administer the medication PRN (as needed). B) Administer the mediation when pain has peaked. C) Administer the medication around the clock at timed intervals. D) Administer the medication when the child complains of pain.

C. With any medication administered for pain management, the timing of administration is vital. Timing depends on the type of pain. For continuous pain, the current recommendation is to administer analgesia around the clock at scheduled intervals to achieve the necessary effect.

The nurse is preparing a child for a lumbar puncture. How far ahead of the procedure should the nurse apply the EMLA cream? A) 30 minutes B) 1 hour C) 3 hours D) 4 hours

C. - For a deeper procedure such as a lumbar puncture, the nurse needs to apply the cream 2 to 3 hours before the procedure. - For a superficial procedure, the EMLA cream should be applied at least 1 hour before the procedure.

The nurse is caring for a child who is experiencing pain related to chemotherapy treatment. What is a behavioral factor that might affect the child's pain experience? A) Knowledge of the therapy B) Fear about the outcome of therapy C) Participation in normal routine activities D) Ability to identify pain triggers

C. - Participation in normal routine activities is a behavior factor. - Knowledge of the therapy and ability to identify pain triggers are cognitive factors. - Fear about the outcome of therapy is an emotional factor. - Situational factors involve factors or elements that interact with the child and his or her current situation involving the experience of pain.

The nurse has applied EMLA cream as ordered. How does the nurse assess that the cream has achieved its purpose? A) Assess the skin for redness. B) Note any blanching of skin. C) Lightly tap the area where the cream is. D) Gently poke the child with a needle.

C. The nurse should verify that sensation is absent by lightly tapping or scratching the area. - Blanching or redness indicates that the medication has penetrated the skin adequately but does not indicate that sensation is absent.

The nurse is teaching an 8-year-old child and his family how to manage cancer pain using nonpharmacologic methods. Which parent statement signifies successful child teaching? A) 'I will avoid using descriptive words like pinching, pulling, or heat.' B) 'I will not use positive reinforcement until the technique is perfected.' C) 'I will begin using the technique before he experiences pain.' D) 'I will be honest and tell him that the procedure will hurt a lot.'

C. The parents should begin using the technique chosen before the child experiences pain or when the child first indicates he is anxious about, or beginning to experience, pain. - The parents should use descriptive terms like pushing, pulling, pinching, or heat and avoid overly descriptive or judgmental statements such as, "This will really hurt a lot" or "This will be terrible." - They should offer praise, positive reinforcement, hugs, and support for using the technique even when it was not effective.

The nurse is conducting a pain assessment of a 10-year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action? A) Increase the dosage of the acetaminophen. B) Tell the child he is experiencing the ceiling effect. C) Use guided imagery to help his pain. D) Obtain an order for a different medication.

D.

The nurse is providing instructions to a mother on how to use thought stopping to help her child deal with anxiety and fear associated with frequent painful injections. Which statement indicates the mother understands the technique? A) "We will imagine that we are on the beach in Florida." B) "We can talk about our favorite funny movie and laugh." C) "She can let her body parts go limp, working from head to toe." D) "We'll repeat 'quick stick, feel better, go home soon' several times."

D. - Thought stopping is a technique that involves the use of short, concise phrases of positive ideas. Doing so helps to promote the child's sense of control. - Talking about a favorite funny movie involves humor.

The nurse is counseling the parents of a 9-year-old boy who is receiving morphine for postoperative pain. Which statement from the nurse accurately reflects the pain experience in children? A) 'You can expect that your child will tell you when he is experiencing pain.' B) 'Your child will learn to adapt to the pain he is experiencing.' C) 'Your child will experience more adverse effects to narcotics than adults.' D) 'It is very rare that children become addicted to narcotics.'

D. Addiction to narcotics when used in children is very rare. Often children deny pain to avoid a painful situation or procedure, embarrassment, or loss of control.

The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which adverse effect of the medication? A) Epidural hematoma B) Arachnoiditis C) Spinal headache D) Respiratory depression

D. The nurse needs to monitor for signs of respiratory depression, a potential adverse effect of the opioid medication.

The nurse uses the FLACC behavioral scale to assess a 6-year-old's level of postoperative pain and obtains a score of 9. The nurse interprets this to indicate that the child is experiencing: A) little to no pain. B) mild pain. C) moderate pain. D) severe pain.

D. With the FLACC behavioral scale, five parameters are measured and scored as 0, 1, or 2. They are then totaled to achieve a maximum score of 10. The higher the score, the greater the pain. A score of 9 indicates severe pain.

The nurse is conducting an assessment of a high school track athlete. The client tells the nurse he is experiencing pain along his outer thigh. He describes it as tight, achy, and tender, particularly after he runs. The nurse understands that he is most likely experiencing what kind of pain? A) Cutaneous B) Neuropathic C) Visceral D) Deep somatic

D. Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones. It can be localized or diffuse and is usually described as dull, aching, or cramping with tenderness. It can also be due to overuse injuries commonly experienced by athletes.

Pentazocine is prescribed for a child with moderate pain. The nurse identifies this drug as an example of which type? A) Nonsteroidal anti-inflammatory drug (NSAID) B) Prostaglandin inhibitor C) Opioid D) Mixed opioid agonist-antagonist

D. Pentazocine is classified as a mixed opioid agonist-antagonist.

When developing the plan of care for a child in pain, the nurse identifies appropriate strategies aimed at modifying which factor influencing pain? a.Gender b.Cognitive level c.Previous pain experiences d.Anticipatory anxiety

D. Situational factors such as anticipatory anxiety are those factors that interact with the child and the current situation involving the experience of pain. These factors are highly variable. - Gender, cognitive level, and previous pain experiences are factors that cannot be modified.

The nurse is using the acronym QUESTT to assess the pain of a child. Which is an accurate descriptor of this process? A) Question the child's parents. B) Understand the child's pain level. C) Establish a caring relationship with the child. D) Take the cause of pain into account when intervening.

D. The acronym QUESTT stands for the following: Question the child. Use a reliable and valid pain scale. Evaluate the child's behavior and physiologic changes to establish a baseline and determine the effectiveness of the intervention. The child's behavior and motor activity may include irritability and protection as well as withdrawal of the affected painful area. Secure the parent's involvement. Take the cause of pain into account when intervening. Take action.