Pediatric PrepU Chapter 36.

A pediatric nurse is caring for children on a surgical unit. When would the nurse advocate for the use of a patient-controlled analgesia (PCA)? a. if the child's pain is constant or frequent. b. if the child is old enough to self-administer medication. c. if the child has intermittent pain. d. if the child is 5 years old or older.

a. if the child's pain is constant or frequent.

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. a. Word-graphic rating scale. b. FACES pain rating scale. c. Numeric pain scale. d. Adolescent Pediatric Pain Tool. e. Poker chip tool.

b. FACES pain rating scale. e. Poker chip tool.

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? a. Use the Adolescent Pediatric Pain Tool. b. Have child keep a diary of when pain occurs. c. Use a numerical score. d. Use the Pain Experience Inventory.

b. Have child keep a diary of when pain occurs.

The nurse is preparing to administer an antibiotic injection to a 6-year-old child who is developmentally delayed. The parent is concerned because the child typically does not respond well to pain. The parent asks the nurse why the child reacts this way. What is the best response by the nurse? a. "Maybe we should talk to your health care provider to see if the injections are really needed." b. "Have you tried talking to your child more about what the child is feeling when faced with a painful procedure?" c. "Children who are developmentally delayed often do not know how to respond to pain." d. "Children with developmental delays may respond this way to painful procedures."

c. "Children who are developmentally delayed often do not know how to respond to pain."

The nurse is caring for a 6-year-old child with burns on both hands. Which pain assessment technique provides the most accurate data for this client? a. Assess client behavior. b. Objective assessment of the burns. c. Interpret physiological indicators. d. Obtain a self-report.

d. Obtain a self-report.

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? "Adults as well as children can suffer from respiratory depression if given too much morphine." "Opiates can be given to children without untoward effects." "Children should not be given morphine, because they are at risk for respiratory depression." "There is no more danger of respiratory depression in children than in adults."

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

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. a. Take action. b. Question the child. c. Use your own knowledge. d. Suggest commonly helpful interventions. e. Take the child's vital signs. f. Excuse aggressive or nonresponsive behaviors of the child.

a. Take action. b. Question the child.

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

c. The nurse can visualize a blanching effect.

Which nursing intervention demonstrates proper use of cutaneous stimulation to relieve pain in pediatric clients? a. Gently massaging a preterm infant's leg for 2 minutes prior to obtaining a blood sample from a heel stick. b. Use of a cold pack for the treatment of cellulitis on an extremity. c. Use of a heat pack after abdominal surgery for a 2-week-old infant with necrotizing enterocolitis. d. Use of a cold pack for 20 minutes to achieve a muscle temperature of 104°F (40°C).

a. Gently massaging a preterm infant's leg for 2 minutes prior to obtaining a blood sample from a heel stick.

Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain? a. Numeric pain intensity scale. b. Poker chip tool. c. FACES pain rating scale. d. Oucher pain rating scale.

a. Numeric pain intensity scale.

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? a. Riley Infant Pain Scale. b. The FLACC behavioral scale. c. The Neonatal Infant Pain Scale. d. The Pain Observation Scale for Young Children.

a. Riley Infant Pain Scale.

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. a. "My child seems to cry a lot less with medical procedures if we are reading a book together." b. "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." c. "I'm not sure if I am imagining it, but I think my child seems to be in less pain when I rock her." d. "I try to remind our child to think about our dog at home. Our dog is like a big cuddle toy to our child." e. "Pain medications are more effective than nonpharmacologic methods for postoperative pain."

a. "My child seems to cry a lot less with medical procedures if we are reading a book together." b. "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." c. "I'm not sure if I am imagining it, but I think my child seems to be in less pain when I rock her." d. "I try to remind our child to think about our dog at home. Our dog is like a big cuddle toy to our child."

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? a. "This is referred pain and is normal after surgery." b. "I will bring pain medication to relieve the pain." c. "This is visceral pain and comes from internal organs." d. "I will need to contact the health care provider about it."

a. "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? a. "This medication should be taken on an empty stomach." b. "I may experience an upset stomach on this medication." c. "Taking this medication with food is often helpful to prevent me from feeling sick." d. "This medication may cause me to bruise easier than I normally do."

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

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? a. "You might experience decreased sensation and ability to move your legs while using this route of medication." b. "Press the button every two hours whether you are in severe pain or not." c. "Press the red button when you experience high levels of pain." d. "Tell your parents they need to press the button for you if you fall asleep."

a. "You might experience decreased sensation and ability to move your legs while using this route of medication."

The nurse is caring for a group of children who have had recent surgery. Which children will the nurse question to determine the location of their pain? Select all that apply. a. 4-year-old with a fractured tibia. b. 3-year-old post tonsillectomy. c. 6-year-old with juvenile arthritis. d. 5-year-old with sickle cell crisis. e. 7 year old post appendectomy. f. 2-year-old post myringotomy.

a. 4-year-old with a fractured tibia. b. 3-year-old post tonsillectomy. c. 6-year-old with juvenile arthritis. d. 5-year-old with sickle cell crisis. e. 7 year old post appendectomy.

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 risk for constipation related to opioid analgesic agents. What would be the best goal for this client's risk? a. Client will have a soft, formed bowel movement daily. b. Client will voice no difficulty with bowel movements. c. Client will have a bowel movement without difficulty. d. Client will not be constipated during the stay in the facility.

a. Client will have a soft, formed bowel movement daily.

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? a. Close the door to the client's room, dim the lights, and close the curtains before beginning. b. Ask parents and visitors to leave the room during this intervention. c. Begin the intervention by having the child breathe in and out quickly 10 times. d. Allow the television to remain on during this intervention to provide distraction for the client.

a. Close the door to the client's room, dim the lights, and close the curtains before beginning.

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? a. Developmental age of child. b. Chronological age of child. c. Pain medication used and last dose administered. d. Reason for the pain.

a. Developmental age of child.

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? a. Educate the parents about the need for pain relief in proper doses. b. Explain to parents that children perceive pain differently. c. Implement complementary therapies in place of opioid pain medication. d. Acknowledge parental fear and withhold the opioid pain medication.

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

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. a. Elevate the extremity on a pillow. b. Perform acupressure to the area. c. Apply an ice pack to the site. d. Gently massage the area. e. Soak the foot in warm water.

a. Elevate the extremity on a pillow. c. Apply an ice pack to the site.

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? a. Face, leg, activity, cry, and consolability (FLACC) descriptors. b. Numeric rating scale. c. Pain diary. d. Adolescent pediatric pain tool (APPT).

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

The nurse is assessing the pain level of a child newly admitted to the pediatric orthopedic unit with a fractured femur. The client denies pain, but the nurse suspects the child is having leg pain based on what observations? a. The child guards the leg when the nurse reaches to touch it. b. The child's oxygen saturation level is at the low end of normal. c. The child has an elevated pulse and respiratory rate. d. The child is lying on one side and drawing his knees up to the abdomen. e. The child has not smiled during the entire conversation and assessment.

a. The child guards the leg when the nurse reaches to touch it. b. The child's oxygen saturation level is at the low end of normal. c. The child has an elevated pulse and respiratory rate. e. The child has not smiled during the entire conversation and assessment.

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? a. The child may be in pain. b. The child wants attention. c. The child is afraid of the nurse. d. The child is acting out.

a. The child may be in pain.

An infant has a surgical repair of a congenital heart defect. In the immediate postoperative period, which scenarios best indicate that the infant is in pain? Select all that apply. a. The infant appears restless and wrinkles the face. b. The infant cries and clenches a fist. c. The infant shows a lack of interaction. d. The infant exhibits a weak suck when feeding.

a. The infant appears restless and wrinkles the face.

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 PRN pain medication options on the medication administration record. Which medication should the nurse administer? a. acetaminophen. b. fentanyl. c. morphine. d. naproxen.

a. acetaminophen.

The nurse is planning to supplement pain medication with nonpharmacologic techniques for a child having multiple painful procedures. Which techniques are helpful for pain relief? Select all that apply. a. aroma therapy. b. magnet therapy. c. transcutaneous electrical nerve stimulator. d. acupuncture and acupressure. e. biofeedback. f. guided imagery.

a. aroma therapy. b. magnet therapy. c. transcutaneous electrical nerve stimulator. d. acupuncture and acupressure. e. biofeedback. f. guided imagery.

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? a. conscious sedation. b. diphenhydramine. c. IV hydromorphone. d. IV morphine.

a. conscious sedation.

A nurse is providing immunizations to a 5-year-old client. What strategy uses the gate-control theory of pain to reduce immunization pain for this client? a. having child count during administration of the immunization. b. telling the child to close their eyes and hold their breath during the immunization. c. letting the child look at the needle prior to administration of the immunization. d. asking the parents to provide acetaminophen prior to the immunization.

a. having child count during administration of the immunization.

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. a. no owie. b. no hurt. c. no discomfort. d. no boo-boo. e. no pain.

a. no owie. b. no hurt. d. no boo-boo.

The neonatal nurse is preparing to perform a heel prick for blood work on a 3-day-old infant. Which procedural pain management will the nurse provide the client? a. pacifier with oral glucose. b. high-contrast images to look at. c. oral acetaminophen. d. singing a lullaby.

a. pacifier with oral glucose.

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: a. pain threshold. b. pain peak. c. pain tolerance. d. pain duration.

a. pain threshold.

When caring for a child in chronic pain, the focus of nursing interventions should be on: a. regaining or achieving developmental tasks and decreasing attention to pain behaviors. b. family involvement, relaxation, and encouraging a productive role. c. rest, symptomatic treatment, and avoiding stress. d. medication use, relaxation, and sleep.

a. regaining or achieving developmental tasks and decreasing attention to pain behaviors.

The nurse is completing a CRIES Scale for an child who had surgery a few hours ago. Which elements will be included in the assessment? Select all that apply. a. sleeping activities. b. position/movement of the lower extremities. c. activity. d. facial expression. e. vital signs.

a. sleeping activities. d. facial expression. e. vital signs.

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? a. "Rub the painful area afterwards." b. "Focus on a story during the blood draw." c. "Let the child 'draw blood' from a doll." d. "Explain the procedure in advance."

b. "Focus on a story during the blood draw."

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

b. "I should give my toddler one baby aspirin."

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? a. "For the safety of your child, I cannot give additional pain medication at this time." b. "Oral medications take about 45 minutes to start working. I will be back in 20 minutes to check the pain level again." c. "You need to be patient and wait for the medicine I gave your child to work." d. "Please return to your child's room and I will be there in a moment to assess your child."

b. "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? a. "Mrs. Jones, why don't you have him sit on your lap?" b. "Pick your favorite Band-Aid and show me which arm to use." c. "See how fast you can make this pinwheel whirl." d. "What questions do you have about what I am doing?"

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

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. a. "Distraction has been researched to not be very effective with pain management." b. "Using media such as TV or movies can be a distraction technique." c. "Distraction is helpful because it helps to lessen the pain." d. "The underlying principle of distraction is focusing on stimuli other than the pain being experienced." e. "Some people may find singing or counting a good form of distraction."

b. "Using media such as TV or movies can be a distraction technique." d. "The underlying principle of distraction is focusing on stimuli other than the pain being experienced." e. "Some people may find singing or counting a good form of distraction."

The nurse is caring for children on a postoperative unit. Which nursing action promotes the most efficient pain control? a. Avoid opioids as these may cause dependency and respiratory depression. b. Anticipate when pain will occur and plan interventions to prevent it. c. Instruct parents to notify the nurse if the child's pain worsens. d. Assess the child's pain on a scale of 0 to 10, with 10 being the worst.

b. Anticipate when pain will occur and plan interventions to prevent it.

The nurse plans to apply a cream with lidocaine and prilocaine to decrease the pain of an injection. What would be the best technique? a. Wipe it off at least 15 minutes before the procedure. b. Apply it at least 1 hour before the procedure. c. Apply it immediately prior to the painful procedure. d. Do not cover it after application to prevent it from discoloring.

b. Apply it at least 1 hour before the procedure.

A 3-year-old client requires a peripheral blood draw and the parents wish to use topical lidocaine and prilocaine cream for the blood draw. What will the nurse recommend for the use of topical lidocaine and prilocaine cream to this family? Select all that apply. a. Clean the site with alcohol before applying the cream. b. Cover the cream with an occlusive dressing once applied. c. Apply the cream 1 hour before the blood draw occurs. d. Apply the cream upon arrival to the clinic for the blood draw. e. Tell the child they will not feel any pain with the blood draw.

b. Cover the cream with an occlusive dressing once applied. c. Apply the cream 1 hour before the blood draw occurs.

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

b. Ensure naloxone is readily available.

When educating a parent on how to support the child while experiencing a painful procedure, what is the best information for the nurse to convey? a. Have the parent continuously apologize to the child during the procedure. b. Explain in detail the role of the parent as a coach and emphasize the coping plan. c. Encourage the parent to stay with the child no matter how the child reacts. d. Encourage the parent to focus on the procedure itself.

b. Explain in detail the role of the parent as a coach and emphasize the coping plan.

The 2-month-old infant needs a capillary blood specimen obtained. In addition to having the father hold the infant, what can the nurse do to comfort the child? Select all that apply. a. Give the child an age-appropriate dose of ibuprofen. b. Give the baby a small amount of sucrose just prior to the procedure. c. Provide a pacifier for the child. d. Wrap the extremity in a cool towel.

b. Give the baby a small amount of sucrose just prior to the procedure. c. Provide a pacifier for the child.

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? a. Substitute the word-graphic rating scale for the poker chips. b. Give the mother the FACES pain rating scale to use with her son. c. Show the child once more how to use the chips. d. Select the visual analog scale as the best one to use.

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

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? a. Reassess the client's pain level. b. Monitor the client's respiratory status. c. Document the client's pain description. d. Play a game with the client.

b. Monitor the client's respiratory status.

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? a. PCA by accident. b. PCA by proxy. c. incident report. d. PCA by toddler.

b. PCA by proxy.

A nurse is attempting to assess the extent of an injury a 5-year-old child sustained when falling down a flight of stairs. The child is visibly upset but capable of communicating. Which pain scale would be most appropriate to use in this situation? a. CRIES inventory. b. Poker chip tool. c. Pain Experience Inventory. d. FLACC pain assessment tool.

b. Poker chip tool.

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? a. Requires interaction with another person. b. Requires concentration of the child. c. Makes the child laugh. d. Refers to some past positive experience of the child.

b. Requires concentration of the child.

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? a. Explain to the child that this does hurt but will make him or her better. b. Sit with the child and use distractions such as toys during the infusion. c. Apply a local anesthetic to the area prior to infusing the medication. d. Administer the medications when the child is sleeping.

b. Sit with the child and use distractions such as toys during the infusion.

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? a. The child does not have pain. b. The child is using the scale to predict what they would like, not what the child has. c. The child has difficulty focusing on the right side of the scale. d. The nurse must be interpreting the child's degree of pain falsely.

b. The child is using the scale to predict what they would like, not what the child has.

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? a. The child is afraid of the nurse. b. The child received an injection during the previous visit to the emergency room. c. The child thinks he or she is in trouble for breaking the leg. d. The child is not feeling any pain, just scared.

b. The child received an injection during the previous visit to the emergency room.

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? a. The child was fussy but attempting to self soothe. b. The child was fretful and grimacing. c. The child was most likely sleeping during the assessment period. d. The child was resting peacefully.

b. The child was fretful and grimacing.

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? a. The child is most likely tired. b. The child's nonverbal behaviors may indicate the presence of discomfort. c. The child is feeling too shy to communicate any pain or discomfort. d. The child is not experiencing any significant level of pain or discomfort.

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

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

b. anesthetic cream.

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

b. 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? a. naproxen. b. hydromorphone. c. ibuprofen. d. acetylsalicylic acid (aspirin).

b. hydromorphone.

The nurse is caring for a 6-year-old sickle-cell client in an acute care setting. A high priority for this client's plan of care is pain relief. The nurse understands that untreated acute pain can lead to which physiologic effects? a. constipation, nausea, and vomiting. b. impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression. c. nausea, vomiting, migraine headaches, and developmental regression. d. sleep disturbances, nocturnal enuresis, and impaired mobility.

b. impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression.

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? a. intranasal. b. intramuscular. c. oral. d. intravenous.

b. intramuscular.

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? a. 10-year-old child with a broken femur in traction. b. postoperative 6-year-old child who is unable to accurately report pain level. c. 4-year-old child who just had stitches placed. d. 7-year-old child who is getting ready to undergo a dressing change.

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

The nurse is caring for a child who has received postoperative epidural analgesia. Which nursing assessment is priority? a. nausea and vomiting. b. respiratory depression. c. urinary retention. d. pruritus.

b. respiratory depression.

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

c. "Imagine that you are swimming in a cool, shady pool where nothing can harm you."

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

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

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? a. "We should perform the techniques along with him." b. "We need to identify the ways in which he shows pain." c. "We should start the method after he feels pain." d. "We should select a method that he likes the best."

c. "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: a. Chronic somatic pain. b. Acute visceral pain. c. Acute referred pain. d. Chronic cutaneous pain.

c. Acute referred pain.

Moderate sedation is a pain-management technique that is used with children. During moderate sedation for a preschooler, which action would be most important? a. Asking the child to periodically count from 1 to 10. b. Keeping the child's head in a dependent position. c. Assessing vital signs frequently, because they can become depressed. d. Keeping the room absolutely quiet so the child can sleep.

c. Assessing vital signs frequently, because they can become depressed.

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

c. Capillaries dilate and edema reduces to the lower extremity.

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? a. Although the pain is severe at this time a child under the age of 2 will not be able to recall the event. b. There are no studies that consider the impact of pain in infancy on the child later in life. c. Experiences with pain even in infancy can influence an individual's response to pain later. d. Pain that is short in duration in infancy will not influence the child later.

c. Experiences with pain even in infancy can influence an individual's response to pain later.

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? a. Pain related to an invasive procedure. b. Disturbed sleep pattern related to fear of pain. c. Fear related to anticipation of painful procedure. d. Pain related to fear and anxiety of painful procedure.

c. Fear related to anticipation of painful procedure.

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? a. Have the child practice controlled deep breathing. b. Have the child repeat a pleasant thought out loud. c. Have the child blow bubbles. d. Have the child create a mental image of something pleasant.

c. Have the child blow bubbles.

The nurse is instructing the parents of a 5-year-old child receiving morphine via patient-controlled analgesia (PCA) about safe use of the PCA for this child. What will the nurse include in this teaching? a. The parents must never touch the PCA button; only the child may administer a dose. b. The family should ensure additional doses are given after each lockout period by watching the time and pressing the button. c. If administering a PCA dose to their child, the parents must first ensure the child is alert and awake. d. The nurse must complete a respiratory assessment and oxygen saturation before each dose is administered.

c. If administering a PCA dose to their child, the parents must first ensure the child is alert and awake.

An aunt at the bedside of a 7-year-old holds the child's hand and gently traces her fingers up and down the child's arm while talking softly about pleasant experiences on the grandparents' farm. This relative is using what technique to reduce pain? Select all that apply. a. Biofeedback. b. Positive self-talk. c. Nonpharmacologic management. d. Behavioral-cognitive strategy. e. Relaxation.

c. Nonpharmacologic management. d. Behavioral-cognitive strategy. e. Relaxation.

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

c. Opioids can be safely used with children.

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? a. Pain assessment is difficult to measure. b. It is important to keep children free of pain. c. Pain assessment needs to be done at regular intervals. d. Nurses often forget to assess pain.

c. Pain assessment needs to be done at regular intervals.

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? a. The newborn does not have fully developed pain receptors, and therefore needs little or no pain medication. b. Newborns are rarely subjected to painful procedures without anesthesia. c. The newborn's pain pathway components are developed enough at birth to experience pain. d. The newborn will not remember pain and does not need analgesia for painful procedures.

c. The newborn's pain pathway components are developed enough at birth to experience pain.

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? a. Include the child's parents and a child life specialist in the procedure room. b. Delay the procedure until the child can achieve better understanding and acceptance. c. The use of conscious sedation for the lumbar puncture. d. Administration of an oral antianxiety medication prior to the procedure.

c. The use of conscious sedation for the lumbar puncture.

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? a. The client's condition is worsening, making this analgesic regimen ineffective. b. The client is experiencing symptoms consistent with withdrawal between the medication dosing periods. c. Tolerance to the medication is beginning to take effect. d. The child is beginning to display signs consistent with addiction.

c. Tolerance to the medication is beginning to take effect.

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

c. anesthetic cream.

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? a. feeling anxiety about pain. b. not knowing how to express pain. c. fearing getting a "shot" to relieve the pain. d. not having words to describe the pain.

c. fearing getting a "shot" to relieve the pain.

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? a. FLACC scale. b. Wong-Baker FACES scale. c. numerical. d. description of pain.

c. numerical.

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? a. epidural morphine sulfate. b. IV morphine sulfate. c. topical lidocaine cream. d. oral ibuprofen.

c. topical lidocaine cream.

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? a. deep somatic. b. chronic pain. c. visceral. d. neuropathic.

c. visceral.

A young child with leukemia is scheduled for a bone marrow biopsy. The parents have been instructed to apply anesthetic cream to the site prior to the biopsy. Which is the best nursing instruction for the parents? a. "Apply to the skin four hours before the procedure." b. "This can be purchased without a prescription, so you can keep it on hand for future procedures." c. "Apply the cream to the site and leave it open to air until the procedure." d. "Do not let your child remove the dressing because the cream can cause damage if rubbed into the eyes."

d. "Do not let your child remove the dressing because the cream can cause damage if rubbed into the eyes."

A nurse is caring for a boy preparing to undergo a dressing change. Which statement by the father lets the nurse know that the child's pain experience is at risk of being intensified? a. "You can hold my hand if you want to." b. "I will be here for you the whole time." c. "Let's think about something you really like." d. "I hope that you will be a brave boy and not cry."

d. "I hope that you will be a brave boy and not cry."

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? a. "The pain medication is prescribed on a routine basis to keep the pain under control, so I have to give it as prescribed." b. "I agree. Since your child is sleeping the pain must not be too severe. I will hold his pain medication." c. "We need to wait for your child to express the pain level to us before providing medication." d. "I understand why you think your child is not in pain; sleep is often a way for children to cope with pain."

d. "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? a. "Although it is possible for your newborn to experience pain, it is very unlikely for the pain to be intense." b. "Your newborn's nervous system is not developed enough to experience pain." c. "I am sure your newborn is too young to experience any pain." d. "It is hard to know for sure, but research shows that it is possible for newborns to experience pain."

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

A 4-year-old child is being prepared for a colonoscopy with intravenous fentanyl and midazolam. What statement by the parents demonstrates understanding of the nurse's teaching about these medications? a. "Our child will feel all the pain but not have any memories of the procedure." b. "Our child will be alert but will not experience pain during the procedure." c. "Our child will be asleep through the procedure and will not feel pain." d. "Our child will be sleepy but able to respond and will feel minimal pain."

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

d. "Please tell me and all of the nurses when you believe he is 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? a. "Pain medication is available for you. Do you want a dose at this time?" b. "Here is a dose of pain medication so you can be better relaxed while your injury is treated." c. "When you feel you would like a dose of pain medication, I will administer it." d. "Sports injuries can be very painful. Reducing the pain can help in the healing process."

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

The nurse caring for an infant prepares to perform a heel stick. The parents are at the bedside and ask the nurse if their infant will feel pain when stuck. Which is the best response for the nurse to make? a. "Your infant will feel pain, but will never remember this procedure." b. "You should not be concerned about a small routine procedure like a heel stick." c. "There is not enough research to conclude the level of pain infants experience." d. "Your infant will experience pain for a brief moment when the heel is stuck."

d. "Your infant will experience pain for a brief moment when the heel is stuck."

What scenario demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric clients? a. Leading a 6-year-old client in a fairy princess setting where the client is the princess and the nurse is the queen. b. After achieving a relaxed state, begin by guiding the 3-year-old client to imagine a fun birthday party. c. Leading a 4-year-old client to imagine being an airplane pilot and flying across the sky. d. 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.

d. 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.

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? a. Wong-Baker FACES. b. FLACC. c. COMFORT. d. CRIES.

d. CRIES.

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? a. Have the parent wait in the hospital room until the procedure is over. b. Instruct the parent to stay in the back of the procedure room. c. Instruct the parent to help restrain the child during the procedure. d. Have the parent sing softly to the child during the procedure.

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

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? a. Administer a low dose of pain medication. b. Have another nurse hold the infant for comfort. c. Swaddle the infant tightly. d. Provide nonnutritive sucking with sucrose.

d. Provide nonnutritive sucking with sucrose.

What behavioral responses to pain would a nurse observe from an infant younger than age 1? a. Localized withdrawal and resistance of the entire body. b. Low frustration level and striking out physically. c. Passive resistance, clenching fists, and holding body rigid. d. Reflex withdrawal to stimulus and facial grimacing.

d. Reflex withdrawal to stimulus and facial grimacing.

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? a. Ensuring that emergency equipment is readily available. b. Conducting a baseline physical assessment. c. Ensuring the lighting is adequate for the procedure but not so bright to cause discomfort. d. Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen.

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

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? a. Cutaneous. b. Visceral. c. Chronic. d. Somatic.

d. Somatic.

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? a. The child expresses "ouchie" in the ear. b. The child has a temperature of 100°F (38°C). c. The child is crying nonstop. d. The child is pulling on the ear.

d. The child is pulling on the ear.

The nurse working in the emergency department is caring for an 8-year-old boy who was hit by a car while running across the street and has suffered extensive abrasions, contusions, and broken bones. IV morphine analgesia has been given. The child is unable to follow simple directions to allow for procedures to be completed. What is the best action to take for this child? a. Give the child another dose of morphine. b. Restrain the child in order to keep him safe. c. Explain the procedure to the child. d. The child should be sedated.

d. The child should be sedated.

A nurse is admitting a 5-year-old hospitalized child with normal speech and verbal development. Which pain scale will the nurse use to assess this child? a. CRIES Pain Measurement Scale. b. FLACC Pain Assessment Tool. c. COMFORT Behavior Scale. d. Wong-Baker Faces Pain Rating Scale.

d. Wong-Baker Faces Pain Rating Scale.

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? a. Would you point to the cartoon face that best describes your pain? b. Would you point to the spot where your pain is? c. Would you please show me which photograph and number best describes your hurt? d. Would you say that the pain you are feeling is sharp or dull?

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

While caring for a client experiencing the transmission level of nociception, which nursing intervention is appropriate? a. ibuprofen. b. amitriptyline. c. acetaminophen. d. methadone.

d. methadone.

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? a. with milk. b. before meals. c. with a citrus beverage. d. with meals.

d. with meals.