Ch. 36 Questions Maternity And Pediatric Workbook

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? a. "She is asleep, so she must not be in pain." b. "She has never had surgery before." c. "She is very articulate and will tell you how she feels. d. "She has a very easygoing temperament."

a. "She is asleep, so she must not be in pain." RATIONALE: 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. An easygoing temperament and the ability to articulate how she feels will be helpful for the nurse to establish a baseline assessment. If the girl had never had surgery before, she is less likely to have previous memories or episodes of prolonged or severe pain.

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

a. Ensure naloxone is readily available RATIONALE: Respiratory depression, although rare when epidural analgesia is used, is always a possibility. However, when it does occur it usually occurs gradually over a period of several hours after the medication is initiated. This allows adequate time for early detection and prompt intervention. The nurse should also monitor for pruritus, urinary retention, and nausea and vomiting but the priority is to monitor for respiratory depression.

The nurse is preparing to assess the pain of a developmentally and cognitively delayed 8-year old. Which pain rating scales should the nurse choose? a. FACES Pain Rating Scale b. Word-Graphic Rating Scale c. Adolescent Pediatric Pain Tool d. Visual Analog and Numerical Scales

a. FACES Pain Rating Scale RATIONALE: The nurse should select the pain assessment tool that is appropriate for the child's cognitive abilities. The FACES pain rating scale is designed for use with children ages 3 and up. A child with limited reading skills or vocabulary may have difficulty with some of the words listed to describe pain on the word graphic scale. Some of the concepts might be too difficult on the visual analog and numerical scales for a developmentally disabled child. The base age for the adolescent pediatric pain tool is 8 years, but its use would ikely be inappropriate for an 8-year old with cognitive delays

The nurse is providing postsurgical care for a 5-year old. The nurse knows to avoid which question when assessing the child's pain level? a. Would you say that the pain you are feeling is sharp or dull? b. Would you point to the cartoon face that best describes your pain? c. Would you point to the spot where your pain is? d. Would you please show me which photograph and number best describes your hurt?

a. Would you say that the pain you are feeling is sharp or dull? RATIONALE: A preschooler may have difficulty distinguishing between the types of pain such as if the pain is sharp or dull. It also limits the information being obtained by the nurse. They can, however, tell someone where it hurts and can use various tools such as the FACES scale (cartoon faces) or the OUCHER scale (photograph and corresponding numbers) to rate their 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? a. "We should perform the techniques along with him." b. "We should start the method after he feels pain." c. "We need to identify the ways in which he shows pain." d. "We should select a method that he likes the best."

b. "We should start the method after he feels pain." RATIONALE: The parents must understand that they should begin the technique or method chosen before the child experiences pain or when he first indicates he is anxious about or beginning to experience pain. The other statements are accurate.

A nurse is assessing the pain level of an nfant. Which finding is not a typical physiologic indicator of pain? a. Decreased oxygen saturation b. Decreased heart rate c. Palmar sweating d. Plantar sweating

b. Decreased heart rate RATIONALE: Decreased heart rate is not a physiologic response to pain. Instead, infants demonstrate an increased heart rate, usually averaging approximately 10 beats per minute with possible bradycardia in preterm newborns. Decreased oxygen saturation and palmar and plantar sweating are common physiologic responses to pain in the infant.

The nurse is preparing to assess the postsurgical pain level of a 6-year-Old boy. The child has appeared unwilling or unable to accurately report his pain level. Which assessment tool is most appropriate for this child? a. FACES Pain Rating Scale b. FLACC Behavioral Scale c. Oucher Pain Rating Scale d. Visual Analog and Numerical scales

b. FLACC Behavioral Scale RATIONALE: The FLACC behavioral scale is a behavioral assessment tool that is useful in assessing a child's pain when the child is unable to report accurately his or her level of pain or discomfort and is reliable for children from age 2 months to 7 years. The preferred base age for the visual analog and numerical scales is 7 years. The FACES pain rating scale and OUCHER pain rating scale are appropriate for children as young as 3; however, in this situation the FLACC is required due to the child's inability to report his level of pain.

A nurse is caring for a tigear-old child who is exhibiting extreme anxiety and behavior upset prior to receiving stitches for a deep Chin laceration. Which nursing interventionis priority? a. Ensuring that emergency equipment is readily available. b. Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen. c. Conducting an initial assessment of pain to serve as a baseline from which options for relief can be chosen. d. Ensuring the lighting is adequate for the procedure but not so bright to cause discomfort.

b. Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen. RATIONALE: When a child is manifesting extreme anxiety and behavioral upset, the priority nursing intervention is to serve as an advocate for the family and ensure that the appropriate pharmacologic agents are chosen to alleviate the child's distress. Ensuring emergency equipment is readily available and lighting is adequate for the procedure is also part of nursing function, but secondary interventions.

The nurse is assigned to care for a 14-year-old child who is hospitalized in traction for serious leg fractures after an automobile accident. The parents ask the nurse to avoid administering analgesics to their child to help prevent him from becoming addicted. Which response by the nurse is indicated? a. "We can talk with the physician to see about reducing the amount of medications given to reduce the potential for addiction." b. "If there is no history of drug abuse in the family there should be no increased risk for the development of addiction." c. "Administering medications to manage reports of pain is not going to cause addiction." d. "Your child is too young to experience drug addiction

c. "Administering medications to manage reports of pain is not going to cause addiction." RATIONALE: nursing care requires the nurse administer pain medication as needed. The nurse has the authority to discuss the child's pain control needs with the parents. There is no need to discuss the reduction of medications with the physician. Family history of drug abuse is not a factor in the care of this child. Young children can become addicted to analgesics. There is, however, no indication that addiction is a valid concern with this child.

A nurse is applying EMLA as ordered. The nurse understands that EMLA is contraindicated in which situation? a. Infants less than 6 weeks of age b. Children with darker skin c. Infants less than 12 months of age receiving methemoglobin-inducing agents d. Children undergoing venous cannulation or intramuscular injections

c. Infants less than 12 months of age receiving methemoglobin-inducing agents RATIONALE: EMLA is contraindicated in children less than 12 months who are receiving methemoglobin-inducing agents such as sulfonamides, phenytoin, phenobarbital, and acetaminophen. Children with darker skin may require longer application times to ensure effectiveness. EMLA is not contraindicated for children less than 6 weeks of age or those undergoing venous cannulation or intramuscular injections.

The nurse is caring for a 5-year-old child who underwent a painful surgical procedure earlier in the day. The nurse notes the child has not reported pain to any of the nursing staff. Which action by the nurse is indicated? a. Contact the physician to report the child's condition b. Administer prophylactic analgesics c. Observe for behavioral cues consistent with pain d. Encourage the child to report pain

c. Observe for behavioral cues consistent with pain RATIONALE: Children may underreport feelings of pain. They may assume that adults know how they are feeling or they may feel worried about appearing to lose control. The nurse should assess for the presence of behavioral cues that might be consistent with pain. The nurse should not simply administer analgesics without cause.

The nurse is preparing to administer a dose of ketorolac to a 15-year-old adolescent. How should the nurse administer the medication to reduce the potential for gastrointestinal upset? a. Before meals b. With milk c. With meals d. With a citrus beverage

c. With meals RATIONALE: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID. It is associated with gastrointestinal upset. To reduce this side effect the nurse may administer the medication with food.

A pregnant teen voices concerns related to potential paralysis during a discussion about an epidural anesthetic to be administered. What information can be provided to the teen? a. "Paralysis is not a serious concern for the procedure. b. "The spinal cord will not be damaged by the insertion of the epidural catheter." c. "The spinal cord ends above the area where the epidural is inserted. d. "The risk of paralysis is limited because your physician is skilled in the administration of epidurals.

d. "The risk of paralysis is limited because your physician is skilled in the administration of epidurals. RATIONALE: The epidural is placed at the level of L1-2, L. 3-4, or I 4-S. This is below the area of the spinal cord. Advising the child and family that paralysis is not a serious concern trivializes the concerns and does little to promote therapeutic communication. Nurses have the responsibility to provide education to the child and caregivers. Simply telling them that the cord ends above the area of the epidural does not provide the needed information to promote reassurance. Assuring the child and family that their physician has skills does not meet the needed education.

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

d. Respiratory depression RATIONALE: Respiratory depression, although rare when epidural analgesia is used, is always a possibility. However, when it does occur it usually occurs gradually over a period of several hours after the medication is initiated. This allows adequate time for early detection and prompt intervention. The nurse should also monitor for pruritus, urinary retention, and nausea and vomiting but the priority is to monitor for respiratory depression.