Chapter 30: Pain Assessment and Management in Children NCLEX

A child has undergone a lumbar puncture for chemotherapy. As a result, this child has developed a postdural puncture headache. How should the nurse position this child in order to relieve the postdural puncture headache? A. Sitting position for 1 hour after the procedure. B. Supine position for 1 hour after the procedure. C. Supine position for 10 minutes after the procedure. D. Walking slowly for 20 minutes after the procedure.

B (Postdural puncture headache is a common complication after a lumbar puncture. In this scenario, the nurse should position the patient properly. The nurse should make this patient lie down in the supine position for 1 hour after the procedure. Twenty minutes is insufficient to relieve the headache. Sitting or walking around will not relieve the headache.)

A child who is on opioid therapy has come for a follow-up visit to a pain clinic. After assessment, the health care provider adds methylphenidate (Methylin) to the child's regimen. What could be the reason for adding this drug? The child had: A. pruritus. B. experienced sedation. C. dysphonia. D. respiratory depression.

B (Pruritus, sedation, dysphoria, and respiratory depression are side effects of opioid therapy. Methylphenidate (Methylin) is given as an adjuvant drug to reduce the sedation caused by opioids. Hydroxyzine (Hypam) is used to treat pruritus. Haloperidol (Haldol) is used to treat dysphoria. Naloxone (Narcan) is used to treat respiratory depression.)

An important consideration when using the FACES pain rating scale with children is: A. that children color the face with the color they choose to best describe their pain. B. the scale can be used with most children, including those as young as 3 years old. C. the scale is not appropriate for use with adolescents. D. the scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

B (The FACES scale has been validated for children as young as 3 years old to rate pain. The child points to the face that best describes the pain being experienced. The scale is useful for all ages above 3 years, including adults. The scale does not have a means of assessing physiologic data.)

In which developmental stage is the child first able to localize pain and describe both the amount and the intensity of the pain felt? a. Toddler stage c. School-age stage b. Preschool stage d. Adolescent stage

B (The preschool stage is the period when the child is first able to describe the location and intensity of pain, by stating, for example, "Ear hurts bad," when feeling pain. The toddler expresses pain by guarding or touching the painful area, verbalizes words that indicate discomfort such as "ouch" and "hurt," and demonstrates generalized restlessness when feeling pain. The school-age child describes both the location of the pain and its intensity. The adolescent also describes the location and intensity of pain.)

Which is an important consideration when using the FACES Pain Rating Scale with children? A.Children color the face with the color they choose to best describe their pain. B. The scale can be used with most children as young as 3 years of age. C. The scale is not appropriate for use with adolescents. D. The scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

B (The scale can be used with most children as young as 3 years of age.)

A mother reports that her baby is teething and is very uncomfortable. What measures should the nurse suggest to the mother to relieve the baby's discomfort? Select all that apply. A. Administer morphine (Avinza) B. Use frozen teething rings C. Give the child a hard cracker or bread D. Use anesthetic gels available for teething E. Rub some wine on the child's gums and cheeks

B, C, D (A child can be very uncomfortable and irritable during teething. The best intervention is the application of anesthetic gels that are available in the market for teething. The discomfort can also be reduced with the use of frozen rings and bread or hard crackers that the child can chew on. Morphine is prescribed by health care practitioners in cases of severe pain and is not recommended for teething. It is inappropriate to rub wine on the child's gums.)

A 6-year-old is hospitalized with a fractured femur. Based on the nurse's knowledge of opioid side effects, which actions should the nurse include in the patient's plan of care to prevent constipation? Select all that apply. A. Instruct the child to remain supine while in bed. B. Administer docusate sodium (Colace). C. Encourage fluid intake. D. Encourage the child to eat fruit. E. Administer diphenhydramine (Benadryl).

B, C, D (Administration of Colace, a stool softener, can help prevent constipation . Increased fluid and fruit intake (high fiber content) can help prevent constipation. Increased activity helps stimulate peristalsis. Diphenhydramine does not increase peristalsis or prevent constipation.)

The nurse is monitoring a patient for side effects associated with opioid analgesics. Which side effects should the nurse expect to monitor for (Select all that apply)? a. Diarrhea b. Respiratory depression c. Hypertension d. Pruritus e. Sweating

B, D, E (Side effects of opioids include respiratory depression, pruritus, and sweating. Constipation may occur, not diarrhea, and orthostatic hypotension may occur but not hypertension.)

The nurse is caring for a postoperative child. On assessment, the child rated the level of pain as 8. Which drug should be administered to manage the child's pain? A. Tolmetin (Tolectin) B. Fentanyl (Sublimaze) C. Naproxen (Naprosyn) D. Acetaminophen (Tylenol)

B (Opioid medications are found to be effective in managing postoperative pain. Fentanyl is an opioid drug effective both as an anesthetic during surgery and as a sedative in pain management. Tolmetin, naproxen, and acetaminophen are nonopioid sedatives for pain management. They are used for managing pain in mild to moderate conditions and not used for managing severe pain such as postoperative pain.)

A nurse is gathering a history on a school-age child admitted for a migraine headache. The child states, "I have been getting a migraine every 2 or 3 months for the last year." The nurse documents this as which type of pain? a. Acute b. Recurrent c. Chronic d. Subacute

B (Pain that is episodic and that recurs is defined as recurrent pain. The time frame within which episodes of pain recur is at least 3 months. Recurrent pain in children includes migraine headache, episodic sickle cell pain, recurrent abdominal pain (RAP), and recurrent limb pain. Acute pain is pain that lasts for less than 3 months. Chronic pain is pain that lasts, on a daily basis, for more than 3 months. Subacute is not a term for documenting type of pain.

The nurse is starting an intravenous (IV) line on a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on the knowledge that: A. children tolerate pain better than adults. B. children become accustomed to painful procedures. C. children often lie about experiencing pain. D. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

D (Children with chronic illnesses are more likely to identify invasive procedures as stressful compared with children with acute illnesses. There are no data to support the theory that children tolerate pain better than adults. The child has increasing difficulty with numerous and repeated painful procedures rather than becoming accustomed to them. Pain is whatever the experiencing person defines it to be.)

The nurse caring for the child in pain understands that distraction: a. Can give total pain relief to the child. b. Is effective when the child is in severe pain. c. Is the best method for pain relief. d. Must be developmentally appropriate to refocus attention.

D (Distraction can be very effective in helping to control pain; however, it must be appropriate to the child's developmental level. Distraction can help control pain, but it is rarely able to provide total pain relief. Children in severe pain are not distractible. Children may use distraction to help control pain, although it is not the best method for pain relief.)

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on the knowledge that A. children tend to be overmedicated for pain. B. giving large doses of opioids causes euthanasia. C. narcotic addiction is common in terminally ill children. D. large doses of opioids are justified when there are no other treatment options

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

A patient with severe pain was prescribed pentazocine (Talwin). After few weeks the patient tells the nurse that she has severe sweating, tears, a runny nose, and nasal irritation. What is the most likely reason for the patient to have these symptoms? Drug: A. Overdose B. Addiction C. Withdrawal D. Dependence

D (Pentazocine is a mixed opioid agonist and antagonist. Sudden discontinuation of the medication causes withdrawal symptoms. The symptoms of opioid withdrawal are severe sweating, tears (lacrimation), and rhinorrhea, which is characterized by runny nose and nasal irritation. The symptoms of drug overdose (opioid overdose) are sedation, respiratory depression, nausea, and vomiting. Drug addiction (opioid addiction) and drug dependence (opioid dependence) are characterized by strong desire or sense of compulsion to take the drug, suicidal ideation, and depression.)

Physiologic measurements in children's pain assessment are: a. The best indicator of pain in children of all ages. b. Essential to determine whether a child is telling the truth about pain. c. Of most value when children also report having pain. d. Of limited value as sole indicator of pain.

D (Physiologic manifestations of pain may vary considerably and may not provide a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain the body adapts, and these signs decrease or stabilize. These signs are of limited value and must be viewed in the context of a pain-rating scale, behavioral assessment, and parental report. When the child states that pain exists, it does. That is the truth.)

A child is being seen in the emergency department with multiple facial abrasions and lacerations. The combination agent lidocaine, adrenaline, and tetracaine (LAT) is applied topically to the wounds. The purpose of this combination therapy is to A. cleanse the wound. B. promote scab formation. C. prevent infection of the wound. D. provide anesthesia to the wound.

D (Provide anesthesia to the wound.)

The nurse is assessing a child who is on opioid therapy for pain. Which adverse effect should the nurse be aware of in the patient? A. Brain death B. Kidney failure C. Hepatic failure D. Respiratory depression

D (Respiratory depression is the most common side effect of opioid therapy. Opioid therapy does not cause brain death. Opioids can cause urinary retention, but they do not cause kidney damage because they do not impair renal function. Opioids do not impair liver function, so they do not cause hepatic failure.)

The nurse is assessing the behavior of a child with pain using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The nurse notes that the child is restless and maintains a disinterested face. However, the child is consolable by hugging. What score does the nurse give the child based on FLACC scale? A. 0 B. 1 C. 2 D. 3

D (The FLACC pain assessment tool is used to assess pain. Using this scale, the nurse notes each behaviors and rates them. The variables include face, leg, activity, cry, and consolability. The child has a disinterested face, is restless, and is consoled by hugging. The nurse rates each behavior as 1, and the sum yields a score of 3. If the child has no facial expression or has a smiling face with a normal sleep pattern, then the score is 0. A score of 1 is given for variables such as grimacing, restlessness, squirming, moaning, and distractibility. Variables such as constant frowning, kicking, jerking, steady crying, and difficulty being consoled are assigned a score of 2.)

Kyle, age 6 months, is brought to the clinic. His parent says, "I think he hurts. He cries and rolls his head from side to side a lot." This most likely suggests which feature of pain? a. Type c. Duration b. Severity d. Location

D (The child is displaying a local sign of pain. Rolling the head from side to side and pulling at ears indicate pain in the ear. The child's behavior indicates the location of the pain. The behavior does not provide information about the type, severity, or duration.)

A 1-year-old child is suffering from minor pain after a fall. Using a behavioral pain assessment scale, the nurse rates the child's pain at 2 on a 0 -10 pain scale. Which medication should the nurse question in the prescription? A. Codeine sulfate (Codeine) B. Acetaminophen (Tylenol) C. Morphine (Avinza) D. Oxycodone with aspirin (Percodan)

D (The most appropriate medications for minor pain (< 3 on the pain scale) are nonsteroidal antiinflammatory drugs and morphine. Percodan contains aspirin, which is contraindicated in young children because it may cause Reye's syndrome. Drugs such as codeine, acetaminophen, and morphine can be safely prescribed in the children because these drugs do not contain aspirin.)

A child with appendicitis has been treated with preemptive analgesia before undergoing appendectomy. What would be the benefits of this treatment to the child? Select all that apply. A. It decreases postoperative pain. B. It increases the need for analgesics. C. It reduces the length of the patient's hospital stay. D. It improves the success of surgery. E. It decreases the risk of neuropathic pain.

A, C (Preemptive analgesia is a treatment in which local or regional anesthetics and analgesics are administered to the child before a surgery such as appendectomy. It helps reduce postoperative pain and shortens hospital stays. It reduces the need for analgesics by reducing pain in children. Preemptive analgesia does not affect the success of the surgery. Preemptive analgesia has no effect on neuropathic pain, which is seen mostly in patients with cancer.)

The nurse is caring for a child with severe pain and injuries due to an accident. The primary health care provider has prescribed lidocaine-tetracaine (Synera) transdermal patch to relieve pain. Which steps does the nurse follow while applying the patch to the child? Select all that apply. A. Applies the patch for a duration of 20-30 minutes B. Cuts and removes the layers of the patch before applying C. Immediately applies the patch after opening the package D. Ensures that the patch is placed on broken skin E. Ensures that the pores (holes) on the patch are covered by a cloth

A, C (The Synera patch is used to produce analgesic and local anesthetic effects during painful procedures. The patch must be used for only 20-30 minutes to prevent skin irritation. After it is removed from the package, the patch must be applied immediately on the desired site to prevent contamination due to moisture and microbes in the atmosphere. The active ingredients are embedded in the layers of the transdermal patch, so the nurse should not cut or remove the layers of the patch. The patch should never be placed on broken skin because it can irritate the skin surrounding the wound. The holes in the patch should not be covered by a cloth because this will affect absorption of the drug into the skin.)

A 6-year-old is hospitalized with a fractured femur. Based on the nurse's knowledge of pain assessment tools and child development, which assessment tools are most appropriate for this age child? (Select all that apply) A. Oucher scale B. CRIES scale C. Poker chip tool D. Faces pain scale E. Postoperative pain score

A, C, D (A. Oucher scale C. Poker chip tool D. Faces pain scale)

The nurse is caring for a 2-year-old child who returns to the hospital floor after undergoing an operation. Which nonverbal action implies that the child is in pain? Select all that apply. A. Loud crying B. Drowsiness C. Confused look D. Furrowed brow E. Puckering of lips

A, D, E (Crying is the most common manifestation of underlying pain. The child can have furrowed brow, puckered lips, clenched teeth, and turning down of mouth as outward signs of pain. Drowsiness and confused looks are not common body signs to express pain.)

After administering an injection, the nurse provides containment by covering the infant with a blanket roll. What are the probable reasons for this nursing intervention? Select all that apply. A. To decrease stress B. To keep the child awake C. To increase the heart rate D. To make the child feel warm E. To make the infant feel secure

A, E (Containment is a nonpharmacological approach that helps the child feel secure and reduces stress. It can help the infant settle down and stop crying. This therapy is not performed to keep the child awake, and in fact it can help the child sleep. Containment is intended to reduce or maintain the heart beat, not increase it.)

The nurse is caring for a 12-year-old child who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action? A. Request a psychological consultation. B. Ask why the child does not have pain. C. Praise the child for the ability to withstand pain. D. Encourage continued bravery as a coping strategy.

A (A psychological consultation will assist the child in verbalizing fears. This age-group is very concerned with physical appearance. The psychologist can help integrate the issues the child is facing. It is likely that the child is having pain but not acknowledging the pain. Speaking with a psychologist might assist the child in relaying fear and pain. If the child is feeling pain, the nurse should not offer praise for hiding the pain. The nurse should encourage the child to speak up during painful episodes so that the pain can be managed appropriately. Bravery may not be an effective coping strategy if the child is in severe pain.)

Which assessment indicates to a nurse that a 2-year-old child is in need of pain medication? a. The child is lying rigidly in bed and not moving. b. The child's current vital signs are consistent with vital signs over the past 4 hours. c. The child becomes quiet when held and cuddled. d. The child has just returned from the recovery room.

A (Behaviors such as crying, distressed facial expressions, certain motor responses such as lying rigidly in bed and not moving, and interrupted sleep patterns are indicative of pain in children. Current vital signs that are consistent with earlier vital signs do not indicate that the child is feeling pain. Response to comforting behaviors does not suggest that the child is feeling pain. A child who is returning from the recovery room may or may not be in pain. Most times the child's pain is under adequate control at this time. The child may be fearful or having anxiety because of the strange surroundings and having just completed surgery.)

Which nursing action should be implemented to provide effective pain relief in an 11-year-old child with severe pain? A. using a 0-10 numerical scale for assessment B. encouraging the use of traditional pain-relieving methods C. avoiding the use of pain questionnaires for assessment D. avoiding administering morphine (Avinza) to child

A (Common metric systems such as a 0-10 numerical scale are used to assess pain in children. It helps the nurse determine the severity of pain and thus provide effective treatment. Traditional methods may not provide immediate pain relief and may cause drug interactions. Therefore, a customized treatment plan is needed. Pain assessment questionnaires should be used to assess the pain. Morphine (Avinza) can be administered for pain relief to a child with severe pain.)

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. This decision should be based on knowledge that A. it is unjustified and unethical to administer placebos instead of pain medication. B. the absence of a response to a placebo means the child's pain has an organic basis. C. a positive response to a placebo will not occur if the child's pain has an organic basis. D. administering a placebo instead of the usual pain medication is effective in determining whether a child's pain is real.

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

Nonpharmacologic strategies for pain management A. may reduce pain perception. B. make pharmacologic strategies unnecessary. C. usually take too long to implement. D. trick children into believing they do not have pain.

A (Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. Nonpharmacologic techniques should be learned before the pain occurs. With severe pain it is best to use both pharmacologic and nonpharmacologic measures for pain control. The nonpharmacologic strategy should be matched with the child's pain severity and taught to the child before the onset of the painful experience. Some of the techniques may facilitate the child's experience with mild pain, but the child will still know that discomfort is present.)

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. This decision should be based on knowledge that: A. this practice is unjustified and unethical. B. this practice is effective in determining whether a child's pain is real. C. the absence of a response to a placebo means the child's pain has an organic basis. D. a positive response to a placebo will not occur if the child's pain has an organic basis.

A (Placebos should never be given by any route in the assessment or management of pain. Placebos should never be given as a means to determine whether pain is real. Individuals respond differently to placebos; thus the patient's response may not be an accurate measure of pain. Response to a placebo is not a measure of the origin of pain and should never be used as a means of assessing pain.)

The nurse is caring for a 12-year-old child who sustained major burns when putting charcoal lighter on a campfire. The nurse observes that the child is "very brave" and appears to accept pain with little or no response. What is the most appropriate nursing action? A. Request a psychological consultation. B. Ask why the child does not have pain. C. Praise the child for the ability to withstand pain. D. Encourage continued bravery as a coping strategy.

A (Request a psychological consultation.)

The nurse assesses pain in a child by determining the child's functioning in school as one of the assessment parameters. What type of pain is the nurse assessing in the child? Pain due to: A. Migraine B. Skin burns C. Appendectomy D. Orthopedic injury

A (The assessment tool in which a child's school functioning is noted, PedsQL, is usually used for assessing chronic pain. Migraine pain is chronic or recurrent and may have a major impact on the child's performance in school. Skin burns, surgeries such as appendectomies, and orthopedic injury are all associated with acute pain, and assessment of acute pain does not include the assessment of the child's performance in school.)

The nurse is caring for a child receiving intravenous (IV) morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to: a. Administer naloxone (Narcan). b. Discontinue the IV infusion. c. Discontinue morphine until the child is fully awake. d. Stimulate the child by calling his or her name, shaking gently, and asking the child to breathe deeply.

A (The management of opioid-induced respiratory depression includes lowering the rate of infusion and stimulating the child. If the respiratory rate is depressed and the child cannot be aroused, IV naloxone should be administered. The child will be in pain because of the reversal of the morphine. The morphine should be discontinued, but naloxone is indicated if the child is unresponsive.)

Transdermal fentanyl (Duragesic) 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. The most appropriate nursing action is to A. administer meperidine (Demerol) intramuscularly. B. administer morphine sulfate immediate release (MSIR) intravenously. C. use a nonpharmacologic strategy. D. place another fentanyl (Duragesic) patch on the adolescent.

B (Administer morphine sulfate immediate release (MSIR) intravenously.)

A child who has been receiving morphine by the intravenous (IV) route will now start receiving it orally. In order for equianalgesia (equal analgesic effect) to be achieved, the oral dose will be A. same as the IV dose. B. greater than the IV dose. C. one half of the IV dose. D. one fourth of the IV dose.

B (Greater than the IV dose.)

A patient who is on opioid therapy reports having no pain relief from the previously prescribed dosage. The primary health care provider increases the dosage. What is the reason for increasing the dosage? The patient has symptoms of opioid: A. addiction. B. tolerance. C. dependence. D. withdrawal.

B (If the patient reports having no pain relief for the prescribed dosage of opioids, it indicates that the patient has developed opioid tolerance. In this condition the dosage may be increased to provide effective pain relief to the patient. If the patient feels the need to administer the drugs without cause (pain), then the patient has opioid addiction or opioid dependence. Depression, lacrimation, irritability, and anorexia are symptoms of opioid withdrawal.)

When pain is assessed in an infant, it is inappropriate for the nurse to assess for: a. Facial expressions of pain. b. Localization of pain. c. Crying. d. Thrashing of extremities.

B (Infants are unable to localize pain. Frowning, grimacing, and facial flinching in an infant may indicate pain. Infants often exhibit high-pitched, tense, harsh crying to express pain. Infants may exhibit thrashing of extremities in response to a painful stimulus.)

The nurse is caring for a child after a heelstick procedure. What is the best measure to reduce the child's pain and discomfort after the procedure? A. Switching off all the lights in the child's room. B. Swaddling the child after the procedure is finished. C. Leaving the child alone and allowing relaxation time. D. Playing music in the room and dimming the lights.

B (It has been proven that children who get physical contact while in pain are more comforted. Swaddling is the most appropriate technique to comfort a child. Switching off the lights, leaving the child alone in the room, or playing music will not comfort the child. The child may feel frightened and distressed if such measures are taken.)

The nurse is caring for a patient with severe burns. The primary health care provider advises the nurse to administer diazepam (Valium) before administering ketamine (Anesket) to the patient. Why does the primary health care provider give this advice to the nurse? To prevent: A. urticaria B. dysphoria C. hepatotoxicity D. respiratory depression

B (Ketamine is an anesthetic that is given to patients who have pain due to severe burns. It can cause dysphoria, which is associated with anxiety. Therefore, to prevent dysphoria, the patient must be pretreated with benzodiazepines such as diazepam, which has anxiolytic activity. Urticaria is characterized by skin rashes, and anxiolytic medications such as diazepam do not treat skin rashes. Diazepam does not prevent hepatotoxicity. Diazepam can cause respiratory depression, because it depresses the central nervous system.)

Which myth may interfere with the treatment of pain in infants and children? a. Infants may have sleep difficulties after a painful event. b. Children and infants are more susceptible to respiratory depression from narcotics. c. Pain in children is multidimensional and subjective. d. A child's cognitive level does not influence the pain experience.

B (No data are available to support the belief that infants and children are at higher risk of respiratory depression when they are given narcotic analgesics. This is a myth. It is true that infants may have sleep difficulties after a painful event. Pain in children is multidimensional and subjective. The child's cognitive level, along with emotional factors and past experiences, does influence the perception of pain.)

When assessing pain in any child, the nurse should consider that: a. Any pain assessment tool can be used to assess pain in children. b. Children as young as 1 year old use words to express pain. c. The child's behavioral, physiologic, and verbal responses are valuable when assessing pain. d. Pain assessment tools are minimally effective for communicating about pain.

C (Children's behavioral, physiologic, and verbal responses are indicative when assessing pain. The use of pain measurement tools greatly assists in communicating about pain. The child's age is important in determining the appropriate pain assessment tool to use. Developmentally appropriate assessment tools need to be used to effectively identify and determine the level of pain felt by a child. Toddlers may use words such as "ouch" or "hurt" to identify pain, but infants and young children may not have the language or cognitive abilities to express pain. Pain assessment tools when used appropriately are successful and efficient in identifying and quantifying pain with children. Behavioral and physiologic signs and symptoms in combination with pain assessment tools are most effective in diagnosing pain levels in children.)

A lumbar puncture is needed on a school-age child. The most appropriate action to provide analgesia during this procedure is to apply: a. 4% Liposomal Lidocaine (LMX) 15 minutes before the procedure. b. A transdermal fentanyl (Duragesic) patch immediately before the procedure. c. Eutectic mixture of local anesthetics (EMLA) 1 hour before the procedure. d. EMLA 30 minutes before the procedure.

C (Eutectic mixture of local anesthetics (EMLA) 1 hour before the procedure.)

A nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. Which is an important consideration in managing the child's pain? A. Give only an opioid analgesic at this time. B. Increase the dosage of analgesic until the child is adequately sedated. C. Plan a preventive schedule of pain medication around the clock. D. Give the child a clock and explain when he or she can have pain medications.

C (Plan a preventive schedule of pain medication around the clock.)

The nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain A. cannot occur if child is comatose. B. may occur if child regains consciousness. C. requires astute nursing assessment and management. D. is best assessed by family members who are familiar with child.

C (Requires astute nursing assessment and management.)

Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period? A. Codeine B. Methadone C. Morphine D. Meperidine

C (The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone is not available in parenteral form in the United States. Meperidine is not used for continuous and extended pain relief.)

The nurse is using the C.R.I.E.S. pain assessment tool on a preterm infant in the neonatal intensive care unit (NICU). Which is a component of this tool? A. Color B. Reflexes C. Oxygen saturation D. Posture of the arms and legs

C (Oxygen saturation)

When changing a dressing on the leg of a 16-year-old patient who suffered second degree burn injuries, which characteristics of pain expression does the nurse expects to observe? Select all that apply. A. Stomping feet on the ground and screaming, "No!" B. Attempting to move leg out of reach of the nurse. C. Repeatedly stating, "You're hurting me." D. Clinching fists and tensing arms in anticipation. E. Scooting away and asking parents to stop the nurse.

C, D (Developmental characteristics of the adolescent's response to pain include: less vocal protest; less motor activity; more verbal expressions (such as "It hurts" or "You're hurting me"), and increased muscle tension and body control. Stating, "You're hurting me" and muscle tension are expected responses to pain for the adolescent.)

A 2-year-old child has been returned to the nursing unit after an inguinal hernia repair. Which pain assessment tool should the nurse use to assess this child for the presence of pain? a. FACES pain rating tool c. Oucher scale b. Numeric scale d. FLACC tool

D (A behavioral pain tool should be used when the child is preverbal or does not have the language skills to express pain. The FLACC (face, legs, activity, cry, consolability) tool should be used with a 2-year-old child. The FACES, numeric, and Oucher scales are all self-report pain rating tools. Self-report measures are not sufficiently valid for children younger than 3 years of age because many children are not able to self-report their pain accurately.)

The most consistent indicator of pain in infants is A. increased respirations. B. increased heart rate. C. clenching the teeth and lips. D. a facial expression of discomfort.

D (A facial expression of discomfort.)

A nurse is starting an intravenous (IV) line for a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on the knowledge that A. children tolerate pain better than adults. B. children become accustomed to painful procedures. C. children often lie about experiencing pain. D. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

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