Peds Ch. 30 Pain Assessment and Management in Children

The nurse administers morphine (Avinza) through lumbar puncture for a terminally ill child. What is the preferred route of administration if the pain is resistant to the drug? 1 Intrathecal 2 Intravenous 3 Intradermal 4 Intramuscular

1 Administering analgesics for terminally ill patients helps in relieving pain but does not treat the cause of pain. Analgesics such as opioids are administered at double dosages for effective pain management for these patients. The intrathecal route is preferred for administering morphine if the pain is resistant to the drug. Intrathecal administration entails administering the drug into arachnoid or subarachnoid spaces. Intravenous administration is preferred if the pain is sensitive to the drug. Intradermal and intramuscular routes are not used for administering opioids in terminally ill patients. Administering the drug through these routes may reduce absorption.

The nurse is caring for a child weighing 30 kg (66.1 lb) who has been prescribed morphine (Avinza). The nurse reports to the primary health care provider that the patient is having apnea. Which treatment does the primary health care provider prescribe for the patient? 1 A dosage of 0.5 mcg/kg naloxone (Narcan) 2 Discontinuation of morphine (Avinza) after 2 days 3 A standard maintenance dosage of 0.6 mg/kg/day 4 A dosage that is less than 75% of the previous dosage

1 Apnea and respiratory depression are the side effects of opioids such as morphine (Avinza). During this condition naloxone (Narcan), an opioid antagonist, should be administered to treat apnea. Given the child's weight, the drug must be diluted in saline to adjust the dosage. For children who weigh less than 40 kg, a dosage of 0.5 mcg/kg should be administered by diluting 0.1 mg naloxone (Narcan) in 10 mL sterile saline. Suddenly reducing the dosage of morphine to 75% of the initial dosage can worsen the child's condition and cause withdrawal symptoms. The dosage should be gradually reduced until it reaches 0.6 mg/kg/day. Therefore 0.6 mg/kg/day is not a standard maintenance dosage for children in general. The drug should not be stopped immediately after 2 days, because that can cause withdrawal symptoms. A gradual reduction in the dosage will be helpful for the child.

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. What should this decision be based on? 1 This practice is unjustified and unethical. 2 This practice is effective in determining whether a child's pain is real. 3 The absence of a response to a placebo means the child's pain has an organic basis. 4 A positive response to a placebo will not occur if the child's pain has an organic basis.

1 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 an unconscious patient in the intensive care unit (ICU). Which assessment tool does the nurse use to assess the patient's pain? 1 COMFORT scale 2 Visual analog scale 3 Children's Hospital of Eastern Ontario Pain Scale 4 Face, Legs, Activity, Cry, Consolability (FLACC) pain assessment tool

1 The COMFORT scale is a pain assessment tool that is used in ICUs to measure the distress in an unconscious and ventilated patient. Each indicator is scored between 1 and 5 based on the behaviors exhibited by the patient. The visual analog scale is a 10-cm scale marked with numbers and words such as "no pain" on the left and "worst pain" on the right. It is used to measure the pain intensity in conscious patients. FLACC assessment is done by rating the patient's facial expressions, leg movement, activity, cry, and consolability to measure pain. The Children's Hospital of Eastern Ontario Pain Scale reports the most frequently observed behavior to measure pain. Therefore the visual analog scale, FLACC pain assessment tool, and Children's Hospital of Eastern Ontario Pain Scale cannot be used to assess pain in unconscious patients.

The nurse assesses pain in a 9-year-old child using a Hispanic version numeric scale with pain intensity ratings of 0 to 100. Which scale is the nurse using? 1 Oucher Pain Scale 2 Numeric rating scale 3 Adolescent Pediatric Pain Tool 4 Pain Indicator for Communicatively Impaired Children

1 The Oucher Pain Scale was developed to assess pain intensity in children who do not communicate in English. This helps to avoid cultural influence in pain management. It has five versions: Caucasian, African-American, Hispanic, First Nations, and Asian. It contains both numeric and face scale ratings. The numeric rating scale contains numeric ratings on a line from 0 to 100 to measure pain intensity; however, it is not available in a Hispanic version. The Adolescent Pediatric Pain Tool is a multidimensional scale where intensity, quality, and type of pain are assessed. However, cultural factors may interfere with accurate assessment of pain. The Pain Indicator for Communicatively Impaired Children is used to rate pain intensity in children who are unable to communicate.

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? 1 Pain due to migraine 2 Pain due to skin burns 3 Pain due to appendectomy 4 Pain due to orthopedic injury

1 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.

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 expect to observe? Select all that apply. 1 Repeatedly stating, "You're hurting me." 2 Clinching fists and tensing arms in anticipation. 3 Attempting to move leg out of reach of the nurse. 4 Stomping feet on the ground and screaming, "No!" 5 Scooting away and asking parents to stop the nurse.

1, 2 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 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. 1 Encourage fluid intake 2 Encourage the child to eat fruit 3 Administer docusate sodium (Colace) 4 Administer diphenhydramine (Benadryl) 5 Instruct the child to remain supine while in bed

1, 2, 3 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 caring for a 2-year-old child who returns to the hospital floor after undergoing an operation. Which action implies that the child is in pain? Select all that apply. 1 Loud crying 2 Drowsiness 3 Confused look 4 Furrowed brow 5 Puckering of lips

1, 4, 5 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.

The nurse gives a pacifier coated with sugar syrup to an infant before a heel puncture. What is the reason for it? Select all that apply. 1 To relieve the pain 2 To energize the infant 3 To increase drug absorption 4 To increase hormonal activity 5 To decrease behavioral activity

1, 5 In this situation, the nurse is using the nonnutritive sucking technique in reducing pain. The nurse gives a pacifier to the infant before minor painful procedures such as heel punctures. This helps reduce behavioral, physiologic, and hormonal responses to pain. This technique does not energize the neonate. Nonnutritive sucking is believed to reduce hormonal activity and thus reduce pain perception. Nonnutritive sucking has no effect on the kinetics of the drug.

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. 1 It decreases postoperative pain. 2 It improves the success of surgery. 3 It increases the need for analgesics. 4 It decreases the risk of neuropathic pain. 5 It reduces the length of the patient's hospital stay.

1, 5 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.

A child is supposed to be administered opioids, and the nurse finds that the child's weight is 56 kg (123 lb). How would this child's dosage differ from that of average-sized children of the same age? 1 The dosage would be smaller. 2 The dosage would be greater. 3 The dosage would be the same. 4 An adjuvant drug would be added.

2 Generally children metabolize the drugs faster than adults. Therefore the recommended dosages for normal-size children are lower than those of adults. Drug availability and absorption are lower in children who have more adipose tissue. Therefore children who weigh more than 50 kg (123 lb) need a higher dosage of drug than average-sized children of the same age group. A lower dosage will not yield the desired therapeutic effects in this child. Adding another drug may result in harmful drug interactions and therefore should be avoided. Administering same dosage of the drug will not yield the desired therapeutic effect.

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? 1 Sitting position for 1 hour after the procedure 2 Supine position for 1 hour after the procedure 3 Supine position for 10 minutes after the procedure 4 Walking slowly for 20 minutes after the procedure

2 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. Ten minutes is insufficient to relieve the headache. Sitting or walking around will not relieve the headache.

To which class of complementary and alternative medicine does chiropractic therapy belong? 1 Biologic 2 Manipulative 3 Energy based 4 Mind-body training

2 The complementary and alternative medicine therapies are classified into five groups of methods. Chiropractic is a manipulative method of therapy. Food and special diets belong to the biologic class of therapy. Bioelectric and magnetic treatments are energy-based therapies. Hypnosis and spiritual healing are mind-body training methods.

The nurse assesses pain in a patient and rates it as 8 (on a 0-10 numeric pain-rating scale). Which drug is the patient most likely to be prescribed? 1 Ibuprofen (Advil) 2 Morphine (Avinza) 3 Oxycodone (OxyContin) 4 Acetaminophen (Tylenol)

2 When the patient's pain is rated as 8 on a 0 to 10 numeric pain-rating scale, it means the patient had severe pain. Morphine is prescribed as a standard drug used to treat severe pain. If the pain is rated below 7 on the numeric pain-rating scale (moderate pain), oxycodone is administered. Ibuprofen (Advil) and acetaminophen (Tylenol) are used to treat mild pain (which is rated below 5).

The nurse is using a pain tool that rates the intensity, location, and quality of a patient's pain. Which pain tool is the nurse using? 1 The visual analog scale 2 The numeric rating scale 3 Adolescent Pediatric Pain Tool 4 Face, Legs, Activity, Cry, Consolability (FLACC) Pain Assessment Tool

3 A pain scale in which pain location, intensity, and quality are measured is called a multidimensional pain scale. The Adolescent Pediatric Pain Tool is a multidimensional pain scale. A visual analogue scale uses a vertical/ horizontal line, the ends of which are marked as no pain and worst pain respectively. The child is made to place mark on line that best describes the amount of own pain. The numeric rating scale evaluates the intensity of pain in a child. In this scale the child rates the pain numerically, with 0 indicating no pain and 10 indicating the worst pain. The FLACC scale is a behavioral measure scale in which pain intensity is assessed by observing the child's behavior.

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? 1 Switching off all the lights in the child's room 2 Playing music in the room and dimming the lights 3 Swaddling the child after the procedure is finished 4 Leaving the child alone and allowing relaxation time

3 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.

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? 1 Drug overdose 2 Drug addiction 3 Drug withdrawal 4 Drug dependence

3 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.

The nurse is assessing a child with stomach pain. The child's parents tell the nurse that the child had similar symptoms last month, which resolved spontaneously. After the assessment, the nurse finds that the child is free of infection. What does the nurse suggest to the child's parents? 1 Avoid giving foods high in dietary fiber 2 Continue follow-up visits every 6 months 3 Regularly monitor the symptoms of pain in the child 4 Prevent the child from doing deep breathing exercises

3 Recurrent abdominal pain is defined as abdominal pain that occurs at least once a month for 3 consecutive months. Treatment must be given even if there is no evidence of infection. The nurse should ask the parents to continuously monitor the symptoms of pain in the child. Food rich in fiber must be given to the child, because it prevents constipation and prevents abdominal pain. Because recurrent abdominal pain occurs for at least 3 consecutive months, a follow-up visit every 3 to 4 months is necessary. The child may feel stressed by the pain, so the nurse should teach the child relaxation techniques such as deep breathing.

The nurse caring for a child with cancer reports to the primary health care provider (PHP) that the child has stabbing and burning sensations in the legs and arms. The PHP prescribes amitriptyline (Elavil) to the child. What is the reason for prescribing amitriptyline to the child? 1 To treat cancer 2 To treat seizures 3 To treat neuropathic pain 4 To treat myocardial infarction

3 Stabbing and burning sensations in the arms and legs are symptoms of neuropathic pain. Amitriptyline is prescribed for the treatment of neuropathic pain, which is associated with cancer. Unlike anticancer medications such as cisplatin (Platinol), amitriptyline cannot be prescribed for the treatment of cancer. Amitriptyline is a tricyclic antidepressant, and it cannot treat seizures, which are treated with anticonvulsant medications. Aspirin (Acuprin) is prescribed to treat the pain associated with myocardial infarction.

What is an important consideration when using the FACES pain-rating scale with children? 1 The scale is not appropriate for use with adolescents. 2 Children color the face with the color they choose to best describe their pain. 3 The scale can be used with most children, including those as young as 3 years old. 4 The scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

3 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.

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?

3 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.

Fifteen-year-old Brandon has been admitted to the pediatric unit with acute pancreatitis. This is the second time that the patient has been admitted for the same condition. A pain assessment reveals that Brandon has a pain score of 8 (on a 0 to 10 scale). The nurse understands that this is severe pain and the patient will likely need an opioid for optimal pain relief. The provider has ordered hydromorphone (Dilaudid) 0.05 mg/kg intravenously 4 hours. Brandon weighs 136 pounds. Calculate both the dose rounded to a whole number that the patient should receive as well as the maximum amount that he can safely receive in a 24-hour period. Provide answer as whole numbers separated by a comma and space (ex. 2, 3).

3 mg, 18 mg 136/2.2 = 61.8 kg / 61.8 x 0.05 = 3.09 (rounded to 3 mg). 3 mg x 6 doses = 18 mg. It is also important for the nurse to monitor Brandon for side effects. The most common side effect of opioids is respiratory depression. Evaluation of pain should be done every time vital signs are assessed. When pain scores reach 4 to 6, acetaminophen and nonsteroidal antiinflammatory drugs are suitable medications for pain relief.

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? 1 Brain death 2 Kidney failure 3 Hepatic failure 4 Respiratory depression

4 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 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 what? 1 Children tolerate pain better than adults. 2 Children often lie about experiencing pain. 3 Children become accustomed to painful procedures. 4 Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

4 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.

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on what? 1 Children tend to be overmedicated for pain. 2 Giving large doses of opioids causes euthanasia. 3 Narcotic addiction is common in terminally ill children. 4 Large doses of opioids are justified when there are no other treatment options.

4 Large doses of opioids may be needed because the child has become physiologically tolerant to the drug, requiring higher doses to achieve the same degree of pain control. Pain is considered the fifth vital sign, and management of pain is critical to treatment of a child with bone cancer. Continuing studies report that children are consistently undermedicated for pain. The dosage of opioids is titrated to relieve pain, not cause death. Addiction refers to a psychologic dependence on the narcotic medication, which does not occur in terminal care.

The nurse is teaching a group of new parents about long-term consequences of untreated pain in infants. Which statement made by a parent indicates teaching was effective? 1 "Some types of pain are good and are fine to be left untreated." 2 "Leaving pain untreated can give kids a higher tolerance to pain later in life." 3 "Untreated pain in infants is linked with higher incidents of pediatric cancers." 4 "Leaving pain untreated can cause my child to have a learning deficit later in life."

4 Long-term consequences of pain include poor adaptive behaviors, learning deficits, attention deficits, psychosocial problems, and other kinds of problems. Therefore, the nurse includes this in the teaching and the reiteration by the parent indicates learning was effective. It is not true that some types of pain are good, that untreated pain builds tolerance, or that untreated pain contributes to pediatric cancers.

The nurse assesses a Spanish-speaking child who is undergoing chemotherapy to determine the intensity, quality, and type of pain. Which scale might the nurse be using? 1 Bieri scale 2 Oucher Pain Scale 3 Numeric rating scale 4 Adolescent Pediatric Pain Tool

4 The Adolescent Pediatric Pain Tool is a multidimensional scale where intensity, quality, and type of pain are assessed; it is available in a Spanish version. The Bieri scale is a face scale where pain is assessed with faces. It does not assess the intensity, quality, and type of pain. The Oucher Pain Scale was developed to assess pain intensity in children who do not communicate in English and is designed to avoid cultural influences in pain management. The numeric rating scale uses numeric ratings on a line from 0 to 10 to measure pain intensity.

The nurse completes a pain assessment of an unconscious patient in the critical care unit and finds that the total pain score is 20. What does the nurse interpret from this assessment? 1 The patient had the worst pain. 2 The patient had jerks due to pain. 3 The patient had restlessness due to pain. 4 The patient had adequate sedation and pain control.

4 The COMFORT scale is the preferred scale for assessing pain in patients in the critical care unit. It is an unobtrusive method of measuring distress in unconscious and ventilated patients. If the patients' pain score lies between 17 and 26 on this pain scale, it indicates that the patient has adequate sedation and pain control. Therefore a score of 20 on the COMFORT scale indicates that the patient is free of distress. A score greater than 26 on the COMFORT scale would indicate that the patient is in pain. The patient in this situation has adequate pain control, which means that the patient does not perceive pain or have jerks or restlessness due to pain.

The nurse is providing care to a child with chronic back pain. The parents express hesitation in giving the child pain medication. What is the best response by the nurse? 1 Suggest the parents ask other parents what they use for their children's pain. 2 Ask the parents if something traumatic happened to them regarding the use of pills. 3 Tell the parents that there is nothing wrong with drugs, and children use them all the time. 4 Recommend the parents ask the health care provider about chiropractors and massage therapy.

4 The nurse can tell parents who are hesitant about using pharmacologic methods of pain treatment about complementary and alternative medicine options, such as going to the chiropractor or getting massage therapy. What works for one child may not work for another, so it is unsafe to suggest the parents ask other parents. Telling the parents drugs are fine for children and asking about their own experiences with pills are responses that do not address the question and are nontherapeutic.

The nurse is caring for a child with severe trauma due to an accidental fire. The nurse administered oral oxycodone (OxyContin) as a part of treatment; however, the pain was not relieved. Which action taken by the nurse is effective for pain management? 1 Replace the drug with morphine (Astramorph) 2 Prolong the action of the oxycodone medication 3 Add a nonsteroidal antiinflammatory drug (NSAID) 4 Administer a midazolam (Versed)-acetaminophen combination

4 Trauma due to a fire warrants deep sedation; therefore, it is advisable to administer drugs in combination. This includes acetaminophen and midazolam in combination with oxycodone for effective pain management. Morphine and oxycodone have similar effects. Therefore because the patient is not responding to oral oxycodone, the patient is unlikely to respond to morphine too. Prolonging the oxycodone alone may not be effective in managing pain. Adding a nonsteroidal antiinflammatory drug and replacing the drug with morphine may not bring about effective pain relief.

A child who has been receiving morphine intravenously now will start receiving it orally. The nurse should anticipate that, to achieve equianalgesia (equal analgesic effect), the oral dose will be what? 1 The same as the intravenous (IV) dose 2 One fourth of the IV dose 3 One half of the IV dose 4 Greater than the IV dose

4 When the route of morphine administration is changed from IV to PO (by mouth), it is essential that the dosage be increased to achieve an equianalgesic effect. Oral morphine is not as effective at the same dose as IV morphine. The dosage of morphine is increased, not decreased, when the administration route changes from IV to PO. The dosage of morphine is increased, not decreased, when the administration route changes from IV to PO.

The nurse is assessing a 12-year-old child with fever who is prescribed acetaminophen (Tylenol). The child's body weight is 55 kg (121.25 lbs). What is the maximum safe dosage of drug that the nurse can administer to the child daily? Record your answer using a whole number and no punctuation. _________ mg

4000 mg/day To prevent the toxic effects of the medication, the dosage of acetaminophen (Tylenol) should not exceed 4000 mg/day in children. The safe dose for acetaminophen (Tylenol) is 75 mg/kg/day. In this case, the actual dose for the child would be 4125 mg (75 mg x 55 kg = 4125 mg). This dose is more than the recommended safe dose of 4000 mg. Therefore the child should be administered 4000 mg of the drug per day.

A child with severe pain has been prescribed morphine (Avinza). Which route of administration is the nurse most likely to prefer for providing quick relief from pain and preventing morphine toxicity? 1 Sublingual 2 Intramuscular 3 Subcutaneous 4 Intravenous bolus

Drugs such as morphine, fentanyl (Abstral), and hydromorphone have short half-lives. Opiates such as morphine have a narrow therapeutic index. To prevent drug toxicity and provide quick relief, the nurse should administer morphine as an intravenous bolus. When opiates such as morphine are administered sublingually, their analgesic effect decreases because of first-pass metabolism. This also delays the onset of action, so the child has slow relief from pain. Usually the intramuscular route is not preferred for administering medication to children because it is very painful. Subcutaneous drug administration is preferred only when the drug cannot be administered by orally or intravenously, because it causes tissue damage.

A 3-year-old girl has been brought to the emergency department by her parents after a fall down the porch steps. X-ray films indicate a fractured tibia and fibula, which require a closed reduction under anesthesia. The nurse caring for this preschooler postoperatively utilizes the FLACC scale to perform an accurate pain assessment. The patient is moaning and whimpering, grimacing, squirming and restless, and difficult to console and has the unaffected leg drawn up. Using the FLACC scale, calculate this patient's pain score based on the clinical presentation. (look at FLACC scale, Table 30-1)

Face—grimace (1) + Legs—drawn up (2) + Activity—squirming (2) + Cry—moaning and whimpering (1) + Consolability—difficult to comfort (2) = 8.

For which pediatric client is it most appropriate for the nurse to use the FLACC pain assessment tool? 1 6-year-old patient with a continuous IV 2 3-year-old patient receiving a lumbar puncture 3 5-year-old patient who has an ongoing stomachache 4 10-year-old patient with recurrent pain in the left elbow

answer 2- 3 yr old receiving a lumbar puncture The FLACC pain assessment tool is most appropriate and effective for young children or for short, sharp procedural pain, such as during lumbar punctures. Therefore, the patient getting the lumbar puncture is best suited for use of the FLACC tool. The patient with the ongoing stomachache, the continuous IV, and the recurrent pain have recurrent or chronic pain, which do not always correlate with the children's own reports of pain intensity. Also, since they are not infants, the FLACC pain assessment tool would not be appropriate.