Question 1

Kyle,age 6 months,is brought to the clinic. His parent says,&#34;I think he hurts. He cries and rolls his head from side to side a lot.&#34; This most likely suggests which feature of pain?&#10;A)Type&#10;B)Severity&#10;C)Duration&#10;D)Location

Accepted Answer

The child is displaying a local sign of pain. Rolling the head from side to side and pulling at ears indicate pain in the ear. The child's behavior indicates the location of the pain. The behavior does not provide information about the type,severity,or duration.

Question 2

Physiologic measurements in children's pain assessment are:&#10;A)The best indicator of pain in children of all ages.&#10;B)Essential to determine whether a child is telling the truth about pain.&#10;C)Of most value when children also report having pain.&#10;D)Of limited value as sole indicator of pain.

Accepted Answer

Physiologic manifestations of pain may vary considerably,not providing a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear,anxiety,or anger also indicate pain. In chronic pain the body adapts,and these signs decrease or stabilize. These are of limited value and must be viewed in the context of a pain-rating scale,behavioral assessment,and parental report. When the child states that pain exists,it does. That is the truth.

Question 3

Skin-to-skin holding of infants dressed only in diapers next to their mother's or father's chest is commonly known as _________________ care.

Accepted Answer

Kangaroo&#10;Infants who spent 1 to 3 hours in kangaroo care showed increased frequency in quiet sleep,longer duration of quiet sleep and decreased crying in the neonatal intensive care unit. Significant differences were found in pain responses during heel lancing between infants who were kangaroo held and those that were not.

Question 4

Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period?&#10;A)Codeine&#10;B)Morphine&#10;C)Methadone&#10;D)Meperidine

Accepted Answer

The most commonly prescribed medications for PCA are morphine,hydromorphone,and fentanyl. Parenteral use of codeine is not recommended. Methadone is not available in parenteral form in the United States. Meperidine is not used for continuous and extended pain relief.

Question 5

A lumbar puncture is needed on a school-age child. The most appropriate action to provide analgesia during this procedure is to apply:&#10;A)Tetracaine-adrenaline-cocaine (TAC) 15 minutes before procedure.&#10;B)Transdermal fentanyl (Duragesic) patch immediately before procedure.&#10;C)Eutectic mixture of local anesthetics (EMLA) 1 hour before procedure.&#10;D)EMLA 30 minutes before procedure.

Accepted Answer

EMLA is an effective analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. TAC provides skin anesthesia about 15 minutes after application to nonintact skin. The gel can be placed on the wound for suturing. Transdermal fentanyl patches are useful for continuous pain control,not rapid pain control. For maximal effectiveness EMLA must be applied approximately 60 minutes in advance.

Question 6

The nurse is caring for a child receiving intravenous (IV) morphine for severe postoperative pain. The nurse observes a slower respiratory rate,and the child cannot be aroused. The most appropriate management of this child is for the nurse to:

A)Administer naloxone (Narcan).
B)Discontinue IV infusion.
C)Discontinue morphine until child is fully awake.
D)Stimulate child by calling name,shaking gently,and asking to breathe deeply.

Accepted Answer

The management of opioid-induced respiratory depression includes lowering the rate of infusion and stimulating the child. If the respiratory rate is depressed and the child cannot be aroused,IV naloxone should be administered. The child will be in pain because of the reversal of the morphine. The morphine should be discontinued,but naloxone is indicated if the child is unresponsive.

Question 7

Nonpharmacologic strategies for pain management:&#10;A)May reduce pain perception.&#10;B)Make pharmacologic strategies unnecessary.&#10;C)Usually take too long to implement.&#10;D)Trick children into believing they do not have pain.

Accepted Answer

Nonpharmacologic techniques provide coping strategies that may help reduce pain perception,make the pain more tolerable,decrease anxiety,and enhance the effectiveness of analgesics. Nonpharmacologic techniques should be learned before the pain occurs. With severe pain it is best to use both pharmacologic and nonpharmacologic measures for pain control. The nonpharmacologic strategy should be matched with the child's pain severity and taught to the child before the onset of the painful experience. Some of the techniques may facilitate the child's experience with mild pain,but the child will still know that discomfort is present.

Deck 35: Pain Assessment and Management