Ch. 36

Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain?

Numeric pain intensity scale

The nurse is caring for a child who has received postoperative epidural analgesia. Which nursing assessment is priority?

respiratory depression

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?

"Focus on a story during the blood draw."

A child is being treated for pain. The nurse is obtaining a pain history from the parent. Which question(s) would the nurse ask the parent to obtain the appropriate information about the child's pain? Select all that apply.

"Has your child been in pain before?" "Is there any sign your child exhibits that makes you believe the child is in pain?" "When your child has had pain, how did the child react?" "If your child has been treated for pain, how did the child indicate relief?" "Does your child have chronic pain?"

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?

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

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?

"This is referred pain and is normal after surgery."

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."

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?

The child may be in pain.

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?

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

An adolescent is experiencing severe pain due to a sickle cell crisis. Which medication would be best for the nurse to administer?

hydromorphone

A nursery nurse is explaining to a new parent about how to assess the newborn for pain. Which manifestation indicates that an infant is in pain?

inability to be consoled

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?

topical lidocaine cream

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.

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

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?

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

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?

fearing getting a "shot" to relieve the pain

The nurse plans to apply a cream with lidocaine and prilocaine to decrease the pain of an injection. What would be the best technique?

Apply it at least 1 hour before the procedure.

A nurse is explaining to a parent about avoiding the use of aspirin for pain relief for flu-like symptoms. Which rationale does the nurse provide?

Aspirin with the flu can lead to Reye syndrome.

A client comes to the clinic following an ankle injury. The nurse anticipates which therapeutic effect of heat if applied to injury site?

Capillaries dilate and edema reduces to the lower extremity

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?

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

The nurse is caring for children on a postoperative unit. Which nursing action promotes the most efficient pain control?

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

The neonatal nurse is assisting the health care provider with a circumcision. Which pain relief method would be most beneficial?

anesthetic cream

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?

"I should give my toddler one baby aspirin."

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?

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

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?

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

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?

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

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:

"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?

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

What scenario demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric clients?

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 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 reviewing literature about pain management in children. Which statement(s) would the nurse identify as a misconception regarding pain in children? Select all that apply.

Children will be truthful when asked if they are experiencing sensations of pain. Opioid pain medications should not be prescribed for young children due to side effects. Newborns typically do not feel pain due to immature nerve patterns. Behavioral cues often correlate accurately with the intensity of the child's pain .

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?

Client will have a soft, formed bowel movement daily.

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?

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.

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?

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

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?

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

When caring for pediatric clients, which distraction technique is age-appropriate for the nurse to use?

Provide action-oriented video games to a 15-year-old client.

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?

Have the child blow bubbles.

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?

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

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?

The child is pulling on the ear.

A hospitalized school-aged child has had surgery and has a prescription for "as necessary" (PRN) pain medication every 4 to 6 hours. Which assessment(s) will the nurse make to determine the child's current pain level before administering each dose of pain medication? Select all that apply.

Listen to the child's report of pain. Assess if the child is withdrawn or responds to questions. Ask the child to describe the pain. Assess muscular rigidity.

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?

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?

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?

Poker chip tool

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 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?

Requires concentration of the child

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.

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?

Somatic

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

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?

The child should be sedated.

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 factor might intensify the child's postoperative pain experience?

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 scenarios best indicate that the infant is in pain? Select all that apply.

The infant appears restless and wrinkles the face. (ONLY ONE)

When assessing a wound for proper anesthetic effect, which finding would indicate the wound would be ready for suturing?

The nurse can visualize a blanching effect.

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?

The use of conscious sedation for the lumbar puncture.

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?

Wong-Baker Faces Pain Rating Scale

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 p.r.n. pain medication options on the medication administration record. Which medication should the nurse administer?

acetaminophen

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?

conscious sedation

A nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain?

decreased heart rate

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?

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

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.

magnet therapy acupuncture and acupressure transcutaneous electrical nerve stimulator guided imagery biofeedback aroma therapy

A 10-year-old child is scheduled for open reduction and internal fixation of the tibia following a skateboard accident. The nurse anticipates which pain medication and administration method will best provide postsurgical pain relief for this child immediately after surgery?

morphine given as an intravenous injection

A child who is being treated for chronic pain comes to the clinic. During the initial assessment, the nurse notes an abnormal body posture. Which further assessment is most important for the nurse to complete?

neurologic assessment

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?

numerical

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?

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:

pain threshold.

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?

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

The nurse is caring for a 2-year-old postoperative PET client. Which consideration is the most appropriate for this child's developmental stage?

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