Chapter 36 Pain Managment

A newborn who is suspected of having leukemia is being prepared for bone marrow aspiration. The newborn's mother asks whether any type of sedation or anesthesia will be used. What statement should the nurse make in response? "Because this is a painful procedure, your child will receive conscious sedation to alleviate pain." "Because myelination of the peripheral nerves is incomplete at this age, the newborn cannot experience pain. Thus, no sedation is needed." "Because newborns lack memory, no sedation is needed." "Because of the risks involved, your child will not be receiving any sedation."

"Because this is a painful procedure, your child will receive conscious sedation to alleviate pain."

The nurse is caring for a client who has sickle cell anemia and is in a sickle cell crisis. The child is hospitalized for treatment of symptoms and pain management during the crisis. The parents tell the nurse that they don't think their child needs any pain medication because he is sleeping a lot. How should the nurse respond? "I agree. Since your child is sleeping the pain must not be too severe. I will hold his pain medication." "I understand why you think your child isn't in pain; sleep is often a way for children to cope with pain." "I think your child can determine if they are feeling pain better than you can determine it." "The pain medication is ordered on a routine basis to keep the pain under control, so I have to give it as ordered."

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

A nurse is interviewing the mother of a sleeping 10-year-old girl to assess the level of the child's postoperative pain. Which comment should trigger additional questions and necessitate further teaching? "She is asleep, so she must not be in pain." "She has never had surgery before." "She is very articulate and will tell you how she feels." "She has a very easygoing temperament."

"She is asleep, so she must not be in pain." (Just because the girl is sleeping does not mean she is not in pain. Sleep may be a coping strategy or reflect excessive exhaustion due to coping with pain.)

The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching? "This can be taken with other medications we have at home that didn't require a prescription." "This should be given with food to avoid upsetting his stomach." "I should monitor for signs of easy bruising or bleeding gums." "This medication is taken by mouth."

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

The nurse is caring for a 17-year-old child who was sprained her ankle. The physician has prescribed ibuprofen to manage the pain. What statement by the teen indicates the need for further instruction?

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

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

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

The nurse is caring for a 9-year-old boy with episodes of chronic pain. The nurse is educating the parents how to help the child manage pain nonpharmacologically. Which statement indicates a need for further teaching? "We should perform the techniques along with him." "We should start the method after he feels pain." "We need to identify the ways in which he shows pain." "We should select a method that he likes the best."

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

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?

Acetaminophen

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

Acute referred pain

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

Acute referred pain (Referred pain is pain that is perceived at a site distant from its point of origin.)

What scenario demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric clients? After achieving a relaxed state, begin by guiding the 13-year-old client to image of walking down a sandy beach and collecting seashells, a favorite activity Leading a 6-year-old client in a fairy princess setting where the client is the princess and the nurse is the queen After achieving a relaxed state, begin by guiding the 3-year-old client to image of a fun birthday party Leading a 4-year-old client to image being an airplane pilot and flying across the sky

After achieving a relaxed state, begin by guiding the 13-year-old client to image of walking down a sandy beach and collecting seashells, a favorite activity

The nurse is caring for a burn client with orders for oral ibuprofen and morphine PRN to control pain. Which nursing interaction is the most beneficial for the nurse to implement for pain management?

Alternate these medications around the clock to diminish peaks and valleys in pain control.

Moderate sedation is a pain-management technique that is used with children. During moderate sedation for a preschooler, which action would be most important?

Assessing vital signs frequently, because they can become depressed

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

Assessing vital signs frequently, because they can become depressed

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?

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

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

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

A 4-year-old child is scheduled for an MRI. The child's parent is informed that the child will be free of pain but sedated to ensure stillness during the procedure. Which type of anesthesia does the nurse expect this child to have? General anesthesia Conscious sedation IM injection Patient-controlled analgesia (PCA)

Conscious sedation

The nurse is caring for a 7-year-old postoperative child who is reporting an 8 out of 10 on a pain intensity scale. The child's parent is requesting pain medication. The child received ibuprofen 3 hours ago. What is the correct nursing action? Contact the health care provider and request an opioid pain medication. Explain to the parent the child cannot receive another dose of ibuprofen for 3 hours. Turn on the television in hopes to distract the child. Apologize to the parent and tell the parent there is nothing the nurse can do at the moment.

Contact the health care provider and request an opioid pain medication. (The nurse must advocate for the child.)

A nurse is preparing to give an injection to a 7-year-old child who appears afraid and hesitant. The nurse tells the child that it is OK to say "ouch" when the shot is given, using which client pain control technique? Cutaneous stimulation Distraction Anxiety reduction Guided imagery

Distraction

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

Ensure naloxone is readily available

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

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

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

Imagery

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 physiological effects?

Impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression

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 administeration of the medication?

Monitor the client's respiratory status

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 administeration of the medication? Play a game with the client Document the client's pain description Reassess the client's pain level Monitor the client's respiratory status

Monitor the client's respiratory status (It is priority for the nurse to assess the client's respiratory status after administering a narcotic medication.)

The adolescent receiving morphine IV for pain control needs which included in his nursing care plan (NCP)? Select all that apply.

Monitoring for itching Stand-by assistance when using the bathroom Naloxone readily available

The nurse is caring for a child receiving an epidural opioid medication. The nurse will ensure which medication is readily available for this client?

Naloxone

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?

Obtain a self-report

The nurse is planning immediate postoperative care for an infant after repair of a cleft lip. What should the plan include? Encourage use of pacifier after surgery. Allow the infant to be as active as possible after surgery. Pain medication should be given on a routine basis. Crying is good for the infant to decrease risk of pneumonia after anesthetic.

Pain medication should be given on a routine basis. (After any surgery on a child, the plan should include pain medication administration on a routine basis.)

What behavioral responses to pain would a nurse observe from an infant younger than age 1?

Reflex withdrawal to stimulus and facial grimacing

The nurse is caring for a child who has received postoperative epidural analgesia. Which nursing assessment is priority? Urinary retention Pruritus Nausea and vomiting Respiratory depression

Respiratory depression

The nurse is preparing a female toddler for the repair of an eyebrow laceration. The girl is most likely to demonstrate which response in anticipation of the procedure? Scream and cling tightly to her parent. Attempt to postpone the procedure by asking to "go potty." Stare out the window while clenching her hands. Remain outwardly calm and ask numerous questions.

Scream and cling tightly to her parent. (A toddler is most likely to show regressive behaviors such as clinging and crying loudly.)

What are some negative effects that chronic pain can have on the pediatric population? Sleep disturbances, exhaustion, irritability, mood disturbances, and depression Increased appetite, sleep disturbances, and irritability Weight loss, increased blood pressure, and increased heart rate Increased blood pressure, increased heart rate, and sleep disturbances

Sleep disturbances, exhaustion, irritability, mood disturbances, and depression

A young child is in the emergency department with swelling and pain in the right ankle. The client states that while playing soccer, the client somehow twisted the 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? Chronic Cutaneous Somatic Visceral

Somatic (Somatic pain originates from deep body structures, such as muscles or blood vessels. The pain of a sprained ankle is somatic pain.)

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

The child is using the scale to predict what he or she would like, not what the child has.

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

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

The nurse is caring for a 12-year-old postoperative spinal rod placement client with scoliosis. Which factors might intensify the child's postoperative pain experience? The client is 12 years old. The client had a painful experience with an appendectomy at age 10. The parents describe the client as being a difficult child. Pain control methods were discussed with the client prior to the procedure.

The client had a painful experience with an appendectomy at age 10.

An infant has a surgical repair of a congenital heart defect. In the immediate postoperative period, which scenario best indicates that the infant is in pain?

The infant appears restless and wrinkles the face.

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

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

A 12-year-old girl needs a lumbar puncture to collect cerebral spinal fluid for 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? The use of conscious sedation for the lumbar puncture. Administration of an oral antianxiety medication prior to the procedure. Include the child's parents and a child life specialist in the procedure room. Delay the procedure until the child can achieve better understanding and acceptance.

The use of conscious sedation for the lumbar puncture.

Which statement is the goal of distraction techniques used to control pain?

To divert the child's attention away from the pain through controlled, purposeful behaviors

After receiving a pain medication for 7 days, the client has begin to request pain medication more frequently. What inference about this occurrence is most credible? The child is beginning to display signs consistent with addiction. Tolerance to the medication is beginning to take effect. The client is experiencing symptoms consistent with withdrawal between the medication dosing periods. The client's condition is worsening, making this analgesic regimen ineffective.

Tolerance to the medication is beginning to take effect.

The nurse is caring for a 2-year-old postoperative PET client. Which consideration is the mostappropriate for this child's developmental stage? Uses delays to put off treatment Understands time Fears bodily mutation or injury Uses words for pain such as owie, boo-boo, or hurt

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

A 5-year-old arrives at the emergency department and reports abdominal pain. After performing an assessment and laboratory work, the health care provider diagnoses appendicitis. The nurse knows that this child is experiencing which type of pain? Chronic Cutaneous Somatic Visceral

Visceral

The nurse is planning immediate postoperative care for an infant after repair of a cleft lip. What should the plan include?

pain medication should be given on a routine basis.