Peds-Chapter 14-Pain Management
A nurse is instructing the parents of a toddler on the use of an anesthetic cream in advance of an upcoming procedure the child will have. What information should the nurse mention to them? a) Administer the cream about 4 hours before the procedure. b) Be careful not to let your son remove the dressing, as the cream can cause damage to his eyes if he rubs them. c) Do not apply the cream until you are at the hospital, a few minutes before the procedure is to begin. d) Do not cover the site of the cream application with any kind of dressing.
Be careful not to let your son remove the dressing, as the cream can cause damage to his eyes if he rubs them.
Parents are to bring their kindergarten child to the outpatient department for a venous blood sample. They have EMLA cream to apply at home prior to the procedure and have been shown two areas on the child's arms where they should place the cream. Transportation time is 15 minutes. Their appointment is for 2:45 p.m. At what time should the parents apply the cream and occlusive dressings to both arms? a) Between 1:15 p.m. and 1:45 p.m. b) Right before leaving home for the clinic c) At 11:45 a.m. d) The parents should not apply EMLA cream due to their child's age.
Between 1:15 p.m. and 1:45 p.m.
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 very articulate and will tell you how she feels." b) "She has a very easygoing temperament." c) "She has never had surgery before." d) "She is asleep, so she must not be in pain."
"She is asleep, so she must not be in pain."
The nurse is caring for a 9-year-old one-day post-op appendectomy client. She is due to receive a dose of IV morphine. Her mother is at the bedside and asks why her daughter needs another dose of morphine when she received one just 4 hours ago. Which statement shows the nurse's understanding of pain management? a) "Do you want your daughter to be in pain?" b) "I am just following the doctor's orders." c) "The physician has ordered morphine to be given around the clock in order to keep on top of your daughter's postoperative pain." d) "I am certain your daughter will not become an addict in just one day."
"The physician has ordered morphine to be given around the clock in order to keep on top of your daughter's postoperative pain."
A nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain? a) Palmar sweating b) Plantar sweating c) Decreased oxygen saturation d) Decreased heart rate
Decreased heart rate
An adolescent who is a competitive swimmer comes to the emergency department complaining of localized aching pain in his shoulder. He states, "I've been practicing really hard and long to get myself ready for my meet this weekend." The area is tender to the touch. The nurse determines that the adolescent is most likely experiencing which type of pain? 1. Cutaneous pain 2. Deep somatic pain 3. Visceral pain 4. Neuropathic pain
Deep somatic pain
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 patient? a) Pain diary b) Face, leg, activity, cry, and consolability (FLACC) descriptors c) Adolescent pediatric pain tool (APPT) d) Numeric rating scale
Face, leg, activity, cry, and consolability (FLACC) descriptors
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? a) Thought stopping b) Imagery c) Hypnosis d) Biofeedback
Imagery
Which method of pain tools can be used to assess the pain in relation to events and times of day? a) FACES Pain Rating Scale b) Adolescent Pediatric Pain Tool c) Numerical or Visual Analog Scale d) Log and diaries
Log and diaries
The nurse is caring for an infant who will have surgery. What type of pain assessment would the nurse use? a) None, because infants do not feel pain b) None, because infants do not remember pain c) A self-pain rating scale from 1 to 10 d) Observation of facial and body actions
Observation of facial and body actions
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) Encourage the child to report pain b) Observe for behavioral cues consistent with pain c) Administer prophylactic analgesics d) Contact the physician to report the child's condition
Observe for behavioral cues consistent with pain
The nurse realizes that many factors influence a child's pain experience. Which pain scale may be most appropriate to use with the African American 6-year-old? a) Oucher pain rating scale b) 0 to 10 Numeric pain intensity scale c) Pain Observation Scale for Young Children (POCIS) d) CRIES scale
Oucher pain rating scale
Adam is a 14-year-old post-op scoliosis rod surgery client. As the nurse enters the room, she observes the 3-year-old sibling with the PCA button in his hand, pressing the button multiple times. The client and his mother are both asleep. What is the correct term for this action? a) PCA by accident b) Incident report c) PCA by toddler d) PCA by proxy
PCA by proxy
The nurse is assessing an adolescent for a rule-out appendicitis. The nurse is aware the appendix is located in the right lower quadrant. The teenager is complaining of pain in the left lower quadrant. What type of pain should the nurse document? a) Localized pain b) Chronic pain c) Referred pain d) Cutaneous pain
Referred pain Explanation: Referred pain is pain that is perceived at a site distant from the point of origin. Appendicitis appears with referred pain during assessment. Chronic pain is ongoing, localized pain is with a superficial injury, and cutaneous pain is another name for localized pain.
What behavioral responses to pain would a nurse observe from an infant younger than age 1? a) Reflex withdrawal to stimulus and facial grimacing b) Low frustration level and striking out physically c) Localized withdrawal and resistance of the entire body d) Passive resistance, clenching fists, and holding body rigid
Reflex withdrawal to stimulus and facial grimacing Localized withdrawal is experienced by toddlers ages 1 to 3 in response to pain. The nurse would observe passive resistance in school-age children. Preschoolers show a low frustration level and strike out physically
The nurse is assessing the behavioral indicators of a 9-month-old to determine the child's pain level. Which description would be commonly associated with a pain response? a) The baby's eyebrows are drawn together with the eyes closed. b) The child's body may be stiff but does thrash around. c) The child has an angry facial expression with the eyes open. d) The infant responds minimally when a painful area is stimulated.
The child has an angry facial expression with the eyes open.
A young child is hospitalized with pneumonia. Upon admission he informs the nurse that he is not having pain but just a bad cough. A few hours later, the child he begins to complain of pain in his right lower back. This first report of feeling pain refers to: a) pain duration. b) pain peak. c) pain tolerance. d) pain threshold.
pain threshold.
You teach a child to use a FACES pain rating scale prior to surgery. At that time, she points to the smiling face. Following surgery when you suspect she has pain, she points again to the smiling face. You would interpret this as a) she does not have pain. b) you must be interpreting her degree of pain falsely. c) she is using the scale to predict what she would like, not what she has. d) she has difficulty focusing on the right side of the scale.
she is using the scale to predict what she would like, not what she has.
The nurse is listing physiologic indicators of pain in children while teaching a pain management class for peers. Which of the indicators will be included? Select all that apply. a) Body movements b) Change in blood pressure c) Oxygen saturation level d) Palmar sweating e) Facial expression
• Change in blood pressure • Oxygen saturation level • Palmar sweating
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? a) "Because newborns lack memory, no sedation is needed." b) "Because myelination of the peripheral nerves is incomplete at this age, the newborn cannot experience pain. Thus, no sedation is needed." c) "Because of the risks involved, your child will not be receiving any sedation." d) "Because this is a painful procedure, your child will receive conscious sedation to alleviate pain."
"Because this is a painful procedure, your child will receive conscious sedation to alleviate 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: a) Chronic somatic pain b) Chronic cutaneous pain c) Acute referred pain d) Acute visceral pain
Acute referred pain
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? a) Give only the ibuprofen until the client reports higher pain levels. b) Give morphine as little as possible to prevent unwanted side effects. c) Alternate these medications around the clock to diminish peaks and valleys in pain control. d) Give medication when the client asks for it.
Alternate these medications around the clock to diminish peaks and valleys in pain control.
When developing the plan of care for a child in pain, the nurse identifies appropriate strategies aimed at modifying which factors influencing pain? 1. Gender 2. Cognitive level 3. Previous pain experiences 4. Anticipatory anxiety
Anticipatory anxiety
The nurse is caring for a 7-year-old post-op child who is reporting an 8 out of 10 on a pain intensity scale. The child's mother is requesting pain medication. The child received ibuprofen three hours ago. What is the correct nursing action? a) Apologize to the mother and tell her there is nothing you can do at the moment. b) Explain to the mother the child cannot receive another dose of ibuprofen for three hours. c) Contact the physician and request an opioid pain medication. d) Turn on the television in hopes to distract the child.
Contact the physician and request an opioid pain medication.
Which nursing intervention demonstrates proper use of cutaneous stimulation to relieve pain with pediatric clients? a) Use of a cold pack for 20 minutes to achieve a muscle temperature of 40 °C b) Use of a heat pack after abdominal surgery for a 2-week-old infant with necrotizing enterocolitis c) Gently massaging a preterm infant's leg for two minutes prior to obtaining a blood sample from a heel stick d) Use of a cold pack for the treatment of cellulitis on an extremity
Gently massaging a preterm infant's leg for two minutes prior to obtaining a blood sample from a heel stick
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) Infants less than 12 months of age receiving methemoglobin-inducing agents c) Children undergoing venous cannulation or intramuscular injections d) Children with darker skin
Infants less than 12 months of age receiving methemoglobin-inducing agents
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? a) Refers to some past positive experience of the child b) Requires interaction with another person c) Makes the child laugh d) Requires concentration of the child
Requires concentration of the child
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? a) The client is 12 years old. b) The parents describe the client as being a difficult child. c) Pain control methods were discussed with the client prior to the procedure. d) The client had a painful experience with an appendectomy at age 10.
The client had a painful experience with an appendectomy at age 10.
Which statement is the goal of distraction techniques used to control pain? a) To divert the child's attention away from the pain through controlled, purposeful behaviors b) To reduce parental anxiety by entertaining the child c) To include the child in purposeful behaviors in order to have the child feel more in control of the situation d) To relieve pain completely through the use of specific techniques to divert the child's attention away from the pain, thereby eliminating the need for pain medication
To divert the child's attention away from the pain through controlled, purposeful behaviors
The nurse is caring for an adolescent postoperative patient in an acute care setting with PRN pain medication orders of Tylenol and Vicodin. Which of the following should the nurse closely monitor? a) Physical dependency on these medications b) Side effects such as diarrhea, dry mouth, and irritability c) Medication interactions between these drugs d) Total daily dosage of acetaminophen due to liver toxicity
Total daily dosage of acetaminophen due to liver toxicity
The nurse is caring for a child with appendicitis. The nurse understands that this child is experiencing what type(s) of pain? Select all that apply. a) Visceral pain b) Acute pain c) Neuropathic pain d) Deep somatic pain
• Visceral pain • Acute pain
What does the nursing instructor list for students as the major steps of pain conduction? Select all that apply. a) transformation b) transduction c) modulation d) transmission e) perception f) evaporation
• transduction • transmission • perception • modulation
Which type of medication lacks a ceiling effect, and therefore is prescribed in initial doses that must be titrated to achieve pain relief while managing side effects? a) Ibuprofen b) Tylenol c) Aspirin d) Morphine
Morphine
A nurse is caring for a boy preparing to undergo a dressing change. Which statement by the father lets the nurse know that the child's pain experience is at risk of being intensified? a) "Let's think about something you really like." b) "I hope that you will be a brave boy and not cry." c) "I will be here for you the whole time." d) "You can hold my hand if you want to."
"I hope that you will be a brave boy and not cry."
When providing education to a mother regarding pain management for a toddler with otitis media, which statement by the mother indicates further teaching needs for this parent? a) "I should give my toddler one baby aspirin." b) "Use of infant Tylenol is good for my toddler." c) "Ibuprofen can be purchased over the counter to use if my toddler needs it." d) "I don't have to give my child pain medication unless he needs it."
"I should give my toddler one baby aspirin." May cause Reye's syndrome
A child's pain tolerance refers to the point at which the child first senses pain. a) False b) True
False a point above which they are not willing to bear any additional 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? a) "See how fast you can make this pinwheel whirl." b) "Pick your favorite Band-Aid and show me which arm to use." c) "What questions do you have about what I am doing?" d) "Mrs. Jones, why don't you have him sit on your lap?"
"Pick your favorite Band-Aid and show me which arm to use."
A child is scheduled for a bone marrow aspiration at 4 p.m. The nurse would plan to apply EMLA cream to the intended site at which time? 1. 1:30 p.m. 2. 3:00 p.m. 3. 3:30 p.m. 4. 4:00 p.m.
1:30 p.m.
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? a) Ask parents and visitors to leave the room during this intervention. b) Close the door to the client's room, dim the lights, and close the curtains before beginning. c) Allow the television to remain on during this intervention to provide distraction for the client. d) 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 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? a) Include the child's parents and a child life specialist in the procedure room. b) Administration of an oral antianxiety medication prior to the procedure. c) The use of conscious sedation for the lumbar puncture. d) Delay the procedure until the child can achieve better understanding and acceptance.
The use of conscious sedation for the lumbar puncture.
A nursing student correctly identifies that heat is primarily used after the first 24 hours of an injury and has the following effects. (Select all that apply.) a) Reduces edema b) Constricts capillaries c) Increases blood flow to the area d) Dilates capillaries e) Reduces vessel permeability
• Dilates capillaries • Increases blood flow to the area • Reduces edema
The mother of a child who just had abdominal surgery holds his hand and smoothes 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: a) "This is the medication he gets every 4 to 6 hours. It will control his pain for that period of time." b) "He looks comfortable to me and was sleeping each time I checked. The medication given earlier seems adequate." c) "We will check every 4 hours to see if he needs the pain medicine." d) "His vital signs are stable, telling me he must be comfortable." e) "Please tell me and all of the nurses when you believe he is in pain."
"Please tell me and all of the nurses when you believe he is in pain."
The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching? a) "This should be given with food to avoid upsetting his stomach." b) "I should monitor for signs of easy bruising or bleeding gums." c) "This medication is taken by mouth." d) "This can be taken with other medications we have at home that didn't require a prescription."
"This can be taken with other medications we have at home that didn't require a prescription."
A 4-year-old child is scheduled for an MRI. The child's mother 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? a) Conscious sedation b) PCA c) IM injection d) General anesthesia
Conscious sedation
The nurse is caring for a child who has received postoperative epidural analgesia. Which nursing assessment is priority? a) Respiratory depression b) Urinary retention c) Nausea and vomiting d) Pruritus
Respiratory depression
The nurse wishes to reassure a 3-year-old girl that there will be no discomfort when her peripheral IV site is examined. The nurse will use which words? Select all that apply. a) No hurt b) No pain c) No owie d) No boo-boo
• No hurt • No owie • No boo-boo
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) "Your child is too young to experience drug addiction." c) "Administering medications to manage reports of pain is not going to cause addiction." d) "If there is no history of drug abuse in the family there should be no increased risk for the development of addiction."
"Administering medications to manage reports of pain is not going to cause addiction." Explanation: Responsible 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.
After teaching a child's parents about the different methods of distraction that can be used for pain management, which statement by the parents indicates a need for additional teaching? 1. "We'll have her focus on her hand and count each finger slowly." 2. "We'll read some of her favorite stories to her." 3. "We'll have her imagine that she's at the beach this summer." 4. "She likes to play video games, so we'll bring in some from home."
"We'll have her imagine that she's at the beach this summer."
A 5-year-old arrives at the emergency department and reports abdominal pain. After performing an assessment and laboratory work, the physician diagnoses appendicitis. The nurse knows that this child is experiencing which type of pain? a) Chronic b) Visceral c) Somatic d) Cutaneous
Visceral
What are some negative effects that chronic pain can have on the pediatric population? a) Sleep disturbances, exhaustion, irritability, mood disturbances, and depression b) Increased appetite, sleep disturbances, and irritability c) Weight loss, increased blood pressure, and increased heart rate d) Increased blood pressure, increased heart rate, and sleep disturbances
Sleep disturbances, exhaustion, irritability, mood disturbances, and depression
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) With meals b) With milk c) With a citrus beverage d) Before meals
With meals
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 point to the spot where your pain is? b) Would you point to the cartoon face that best describes your pain? c) Would you please show me which photograph and number best describes your hurt? d) Would you say that the pain you are feeling is sharp or dull?
Would you say that the pain you are feeling is sharp or dull?
A nursing instructor is teaching about pain control in children and identifies a need for further teaching when a student states: a) "Children should not be given morphine, because they are at risk for respiratory depression." b) "Adults as well as children can suffer from respiratory depression if given too much morphine." c) "Opiates can be given to children without untoward effects." d) "There is no more danger of respiratory depression in children than in adults."
"Children should not be given morphine, because they are at risk for respiratory depression."
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 select a method that he likes the best." c) "We should start the method after he feels pain." d) "We need to identify the ways in which he shows pain."
"We should start the method after he feels pain." 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.
What scenario demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric clients? a) Leading a 4-year-old male to a guided imagery of him being an airplane pilot and flying across the sky b) Leading a 6-year-old female in a fairy princess setting where she is the princess and the nurse is the queen c) After achieving a relaxed state, beginning a guided imagery of walking down a sandy beach and collecting seashells, a favorite activity of the 13-year-old female d) After achieving a relaxed state, beginning guided imagery of a fun birthday party for a 3-year-old female
After achieving a relaxed state, beginning a guided imagery of walking down a sandy beach and collecting seashells, a favorite activity of the 13-year-old female Guide the child to choose a favorite place. Guided imagery is not appropriate for preschoolers and toddlers.
The nurse plans to apply EMLA cream to decrease the pain of an injection. What would be the best technique? a) Wipe it off at least 15 minutes before the procedure. b) Do not cover it after application to prevent it from discoloring. c) Apply it at least 1 hour before the procedure. d) Apply it immediately prior to the painful procedure.
Apply it at least 1 hour before the procedure.
Conscious sedation is a pain-management technique that is used with children. During conscious sedation for a preschooler, which action would be most important? a) Assessing vital signs frequently, because they can become depressed b) Asking the child to periodically count from 1 to 10 c) Keeping the room absolutely quiet so the child can sleep d) Keeping the child's head in a dependent position
Assessing vital signs frequently, because they can become depressed
The nurse working in pediatrics is aware of the special needs of children related to pain assessment. What is the highest priority for the nurse to consider when completing a pain assessment? a) Reason for the pain b) Pain medication used and last dose administered c) Chronological age of child d) Developmental age of child
Developmental age of child The chronological and developmental ages may differ and care needs to be based on both, but the type of pain assessment tool used will be based on the developmental age.
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 the status of bowel sounds c) Assess for any adverse reaction d) Premedicate with acetaminophen
Ensure naloxone is readily available
When educating a parent how to support their child while experiencing a painful procedure, what is the best information for the nurse to convey to the parents? a) Explain in detail the role of the parent as a coach and emphasize the coping plan. b) Encourage the parents to focus on the time remaining during the procedure. c) Have the parents apologize to the child. d) Encourage the parents to stay with the child no matter how he reacts.
Explain in detail the role of the parent as a coach and emphasize the coping plan.
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? a) Give the mother the FACES pain rating scale to use with her son. b) Select the visual analog scale as the best one to use. c) Show the child once more how to use the chips. d) Substitute the word-graphic rating scale for the poker chips.
Give the mother the FACES pain rating scale to use with her son.
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? a) Sleep disturbances, nocturnal enuresis, and impaired mobility b) Impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression c) Constipation, nausea, and vomiting d) Nausea, vomiting, migraine headaches, and developmental regression
Impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression Unrelieved acute pain can lead to impaired mobility; anorexia, causing poor nutritional intake; delayed wound healing; anxiety and irritability; somatic symptoms; sleep disturbances; avoidance; developmental regression; and increased parental distress.
The nurse is caring for several infants who require heel sticks to obtain a blood sample. Which infant is likely to experience the greatest intensity of pain from this procedure? a) 10-month-old b) Neonate c) Preterm infant d) 2-month-old
Preterm infant
The nurse is caring for a 6-year-old child with burns on both hands. Which pain assessment technique is the most accurate for this client? a) Physiological indicators b) Behavior c) Obtain a self-report d) Assessment of the burns
Obtain a self-report
When caring for a child in chronic pain, the focus of nursing interventions should be on: a) Family involvement, relaxation, and encouraging a productive role b) Regaining or achieving developmental tasks, decreasing attention to pain behaviors, and emphasizing a productive role c) Rest, symptomatic treatment, and avoiding stress d) Medication use, relaxation, and sleep
Regaining or achieving developmental tasks, decreasing attention to pain behaviors, and emphasizing a productive role
The nurse is caring for a client receiving opioid medication for the treatment of postoperative pain. What are common side effects that the nurse should observe for? a) Respiratory depression, constipation, and pruritis b) Hypotension, nausea and vomiting, and diarrhea c) Constipation, hypertension, and disorientation d) Respiratory depression, diarrhea, and hypotension
Respiratory depression, constipation, and pruritis
The emergency department nurse is reviewing the medical record of a recently admitted infant and notes that the child's pain score is 14. The nurse realizes that the infant was assessed using which pain scale? a) The Pain Observation Scale for Young Children b) The Neonatal Infant Pain Scale c) The FLACC behavioral scale d) Riley Infant Pain Scale
Riley Infant Pain Scale
A nurse is caring for a 4-year-old child who is exhibiting extreme anxiety and behavior upset prior to receiving stitches for a deep chin laceration. Which nursing intervention is priority? a) Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen b) Ensuring that emergency equipment is readily available c) Ensuring the lighting is adequate for the procedure but not so bright to cause discomfort d) Conducting an initial assessment of pain to serve as a baseline from which options for relief can be chosen
Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen
A young boy is in the emergency department with swelling and pain in the right ankle. He states that he was playing soccer, somehow twisted the ankle, and could not walk off the field. The physician tells the client that it is only a sprain. Which type of pain is this client experiencing? a) Visceral b) Somatic c) Cutaneous d) Chronic
Somatic
The nurse working in the emergency department is caring for an 8-year-old male 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? a) Give the child another dose of morphine. b) The child should be sedated. c) Explain the procedure to the child. d) Restrain the child in order to keep him safe.
The child should be sedated.
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? a) The newborn's pain pathway components are developed enough at birth to experience pain. b) The newborn does not have fully developed pain receptors, and therefore needs little or no pain medication. c) The newborn will not remember pain and does not need analgesia for painful procedures. d) Newborns are rarely subjected to painful procedures without anesthesia.
The newborn's pain pathway components are developed enough at birth to experience pain.
When assessing a wound for proper anesthetic effect, which finding would indicate the wound would be ready for suturing? a) The nurse can visualize fresh bleeding in the wound bed. b) The nurse can visualize a blanching effect in the wound bed. c) The nurse can visualize a reddened appearance of the wound bed. d) The nurse can visualize a blue tone to the wound bed.
The nurse can visualize a blanching effect in the wound bed. Explanation: When assessing readiness of an anesthetic agent, look for blanching of the wound bed to assess effectiveness. Redness, a blue tone, and fresh bleeding would not indicate a wound is properly anesthetized.
An aunt at the bedside of a 7-year-old holds the child's hand and gently traces her fingers up and down the child's arm while talking softly about pleasant experiences on the grandparents' farm. This relative is using what technique to reduce pain? Select all that apply. a) Behavioral-cognitive strategy b) Biofeedback c) Positive self-talk d) Nonpharmacologic management e) Relaxation
• Nonpharmacologic management • Behavioral-cognitive strategy • Relaxation
The 2½-month-old infant needs a capillary blood specimen obtained. In addition to having the father hold the infant, what can the nurse do to comfort the child? Select all that apply. a) Provide a pacifier for the child. b) Wrap the extremity in a cool towel. c) Give the baby a small amount of sucrose just prior to the procedure. d) Give the child an age-appropriate dose of ibuprofen.
• Provide a pacifier for the child. • Give the baby a small amount of sucrose just prior to the procedure.
The nurse is about to assess pain in the child and will use the QUESTT acronym as a guide to objective and subjective data collection. This acronym stands for: Select all that apply. a) Excuse aggressive or nonresponsive behaviors of the child. b) Suggest commonly helpful interventions. c) Take action. d) Take the child's vital signs. e) Question the child. f) Use your own knowledge.
• Take action. • Question the child. Explanation: Question the child and Take action are accurate. The other descriptors for the acronym are not. The corrected meaning follows: Use a reliable pain scale, Evaluate the child's behavioral and physiologic changes and determine the effectiveness of the intervention, Secure parental involvement, and Take cause of the pain into account when intervening.
An 11-year-old boy is lying quietly in bed watching a DVD. This is his first postoperative day following open reduction of an ankle fracture. One nurse concludes the child does not need his PRN pain medication; another nurse disagrees. Which of the possibilities described is likely to be true? Select all that apply. a) The boy is quiet and focused, not restless and distracted. His pain is under control. b) The 11-year-old is using the DVD to withdraw from his discomfort and is lying still to avoid movement, which exacerbates his pain. c) At the age of 11 years, the child can be expected to let the staff know when he has pain. d) The child may be concerned about getting a "shot" and is avoiding the display of pain behaviors.
• The child may be concerned about getting a "shot" and is avoiding the display of pain behaviors. • The 11-year-old is using the DVD to withdraw from his discomfort and is lying still to avoid movement, which exacerbates his pain.
