Question 1

The nurse is teaching the parents of a child with idiopathic rheumatoid arthritis about chronic pain. Which statement by the parent indicates teaching has been successful?&#10;A)&#34;When children have chronic pain, they may not have the same behavior as those in acute pain.&#34;&#10;B)&#34;It is associated with a single event.&#34;&#10;C)&#34;Chronic pain can be managed successfully with NSAIDs.&#34;&#10;D)&#34;It is sudden and of short duration.&#34;&#10;

Accepted Answer

Option A correctly identifies that chronic pain may not manifest in the same way as acute pain. Option B is incorrect, as chronic pain is not associated with a single event. Option C is only partially correct, as NSAIDs are one of several approaches to managing chronic pain. Option D is incorrect, as chronic pain is not sudden and of short duration.

Question 2

A hospitalized three-year-old needs to have an IV restarted. The child begins to cry when carried into the treatment room by the mother. Which is the most appropriate nursing diagnosis?&#10;A)Knowledge deficit of the procedure&#10;B)Fear related to the unfamiliar environment&#10;C)Anxiety related to anticipated painful procedure&#10;D)Ineffective individual coping related to an invasive procedure&#10;

Accepted Answer

The child crying suggests that the anticipated procedure may be painful and this would cause anxiety for the child. Therefore, the most appropriate nursing diagnosis is Anxiety related to anticipated painful procedure.

Question 3

The nurse is preparing to perform a heel stick on a neonate. The most appropriate complementary therapy for the nurse to plan to use in the neonate to decrease pain during this quick but painful procedure is:

A)Holding the infant.
B)Sucrose pacifier.
C)Massage.
D)Swaddling.

Sucrose pacifier.

Accepted Answer

Sucrose pacifiers have been proven to be effective in reducing pain in neonates during painful procedures. It is believed that the sweet taste of sucrose acts as a natural analgesic and helps to soothe the baby. The other choices (holding the infant, massage, and swaddling) may provide some comfort to the baby, but are not as effective in reducing pain during a heel stick.

Question 4

The 17-month-old infant is terminally ill with cancer and is in constant pain. The nurse recognizes that the best way to control pain in this child would be for the physician to order:&#10;A)Patient-controlled analgesia with the parents controlling the button that administers the dosage.&#10;B)Intravenously administered opioids on a scheduled basis.&#10;C)Intravenously administered opioids on a prn basis.&#10;D)Parenteral administration controls pain more effectively than oral medication as oral absorption may be modified by stomach activities.In addition, providing analgesics on a scheduled basis is preferred over prn.&#10;

Accepted Answer

Intravenously administered opioids on a scheduled basis is the best way to control pain in a terminally ill infant with cancer, as it provides constant pain relief. Patient-controlled analgesia may not be appropriate for an infant of this age, and prn administration may result in peaks and troughs of pain relief. Parenteral administration may be necessary if the infant is unable to tolerate oral medication, but there is no evidence to suggest that it is more effective than oral medication in controlling pain.

Question 5

The clinical nurse specialist is concerned about children's reactions to painful invasive procedures such as intravenous starts. The nurse has decided to use distraction as a means to comfort the school-age child. Depending on the age of the school-age child, which technique might the nurse use to distract the child? Standard Text: Select all that apply.

A)Blowing bubbles
B)Music therapy
C)Guided imagery
D)Hypnosis
E)Sucrose solution

Accepted Answer

Distraction techniques vary with the age and interests of the child. For school-age children, blowing bubbles can be an effective distraction because it is a simple, engaging activity that can divert their attention. Music therapy can be tailored to the child's musical preferences, providing a comforting and familiar distraction. Guided imagery, where the child is led through a calming or interesting scenario in their mind, can also be effective for this age group, as it can help them focus on positive thoughts and feelings away from the procedure. Hypnosis is generally more complex and requires specialized training, making it less likely to be used as a standard distraction technique by nurses. Sucrose solution is primarily used for infants as a pain reliever during minor procedures and is not suitable for school-age children.

Question 6

The nurse is caring for a two-year-old child in the postoperative period. The pain assessment tool most appropriate for assessment of pain intensity in a two-year-old is the:&#10;A)Poker Chip Tool.&#10;B)Oucher Scale.&#10;C)Faces Pain Rating Scale.&#10;D)FLACC Behavioral Pain Assessment Scale.&#10;

Accepted Answer

The FLACC Behavioral Pain Assessment Scale is the most appropriate pain assessment tool for a two-year-old child as it assesses pain through behavioral observations, including facial expressions, leg movement, activity level, cry, and consolability. This tool doesn't rely on self-report which is limited in young children.

Question 7

An analgesic is ordered for a post-surgical patient to be given every three to four hours. The nurse knows that a delay in giving the medication will cause a(n):&#10;A)Decrease in the chance of withdrawal symptoms.&#10;B)Decrease in the chance of addiction.&#10;C)Increase in the chance of breakthrough pain.&#10;D)Increase in the child's pain tolerance.&#10;

Accepted Answer

A delay in giving the analgesic medication will increase the chance of breakthrough pain, as the patient will not have consistent pain relief. Delays in medication administration do not affect the chance of withdrawal symptoms or addiction. Delayed medication administration may also result in increased pain tolerance, but this is not a desirable outcome for the patient.

Question 8

The nurse is working in a pediatric surgical unit. The nurse would expect that patient-controlled analgesia would be most appropriate for which patient?&#10;A)Twelve-year-old who is postoperative for spinal fusion for scoliosis&#10;B)Ten-year-old who has a fractured femur and concussion from a bike accident&#10;C)Five-year-old who is postoperative for tonsillectomy&#10;D)Developmentally delayed 16-year-old who is postoperative for bone surgery.&#10;

Accepted Answer

Patient-controlled analgesia (PCA) is most appropriate for patients who are able to understand and follow instructions for self-administration of pain medication. Therefore, it would be most appropriate for the twelve-year-old who has undergone spinal fusion surgery for scoliosis. The other patients may not have the cognitive ability or developmental level to operate a PCA pump appropriately.

Question 9

The postoperative unit of the pediatric hospital has several children who had surgery this morning. While making rounds, the nurse observes all of the following behaviors. Which child should be further evaluated as to postoperative pain?

A)The six-month-old in deep sleep
B)The two-year-old who is cooperative when the nurse takes his vital signs
C)The four-year-old who is actively watching cartoons
D)The 14-month-old who is thrashing his arms and legs

Accepted Answer

The 14-month-old who is thrashing his arms and legs may be exhibiting signs of pain or discomfort and should be further evaluated by the nurse. The other three behaviors do not necessarily indicate the presence or absence of pain.

Question 10

The nurse administered morphine intravenously to a four-year-old postoperative patient. Thirty minutes later, the nurse assesses the child. Which assessment finding requires further evaluation?&#10;A)Pulse decreased from 136 to 104&#10;B)Blood pressure dropped from 110/72 to 90/55&#10;C)Respiratory rate went from 42 to 16&#10;D)Child pulls away from nurse who wants to assess surgical site&#10;

Accepted Answer

A decrease in respiratory rate from 42 to 16 requires immediate further evaluation as it indicates the potential for respiratory depression, a serious adverse effect of morphine administration. The decrease in pulse and blood pressure may be expected side effects of morphine and should still be monitored, but they do not indicate a need for immediate evaluation. The child pulling away from the nurse may be due to discomfort or fear and also does not necessarily require immediate evaluation.

Question 11

A child who has chronic pain of long duration will exhibit which behavior?&#10;A)Increased respiratory rate&#10;B)Normal temperature&#10;C)Normal heart rate&#10;D)Decreased blood pressure&#10;

Accepted Answer

The answer of A child who has chronic pain of...

Question 12

The nurse is caring for a child who has been sedated for a painful procedure. What is the priority nursing activity for this child?&#10;A)Place the child on a cardiac monitor.&#10;B)Allow parents to stay with the child.&#10;C)Monitor pulse oximetry.&#10;D)Assess the child's respiratory effort.&#10;

Accepted Answer

The answer of The nurse is caring for a child...

Question 13

A nurse is taking care of a patient in the ICU who has been on opioids for an extended period of time. The nurse understands that the child has to slowly wean from the medication over a period of time. While weaning, the nurse will observe the child for symptoms of too rapid withdrawal, including:

A)Hyperactive deep tendon reflexes, vomiting, and abdominal cramps.
B)Bradycardia and pallor.
C)Decreased blood pressure and drowsiness.
D)Voracious appetite and hypotonicity.

Accepted Answer

The answer of A nurse is taking care of a...

Question 14

The nurse is taking care of a seven-year-old child who is postoperative. The child's mother requests that the child not receive narcotics in the postoperative period because she is afraid the child will become addicted. The nurse would explain to the mother that children who do not receive adequate pain control will be at risk for:

A)Respiratory complications.
B)Urinary complications.
C)Cardiac complications.
D)Bowel complications.

Accepted Answer

The answer of The nurse is taking care of a...

Question 15

The mother of a child who is recovering from surgery says to the nurse, "I don't understand why that other nurse told me to stroke his forehead when he is in pain. Why will that make him feel better?" The nurse's response will be based on the knowledge that:

A)Stroking the child's forehead reminds the child of the mother's continued presence, which is reassuring to the child.
B)Stroking causes a non-pain transmission to the brain that competes with the pain transmission and inhibits the pain message from reaching the brain.
C)Stroking causes the release of biochemicals, such as prostaglandins, which block pain transmission.
D)Stroking causes the release of endorphins, which reduce the perception of pain.

Accepted Answer

The answer of The mother of a child who is...

Question 16

A five-year-old child is being discharged from the outpatient surgical center. Which statement by the parent would indicate the need for further teaching?&#10;A)&#34;I will call the office tomorrow if the pain medicine is not relieving the pain.&#34;&#10;B)&#34;I can expect my child to have some pain for the next few days.&#34;&#10;C)&#34;Because my child just had surgery today, I can expect the pain level to be higher tomorrow.&#34;&#10;D)&#34;I will plan to give my child pain medicine around the clock for the next day or so.&#34;&#10;

Accepted Answer

The answer of A five-year-old child is being discharged from...

Question 17

The nurse is caring for a four-year-old child who is intellectually disabled and is scheduled for surgery tomorrow. The nurse wants to plan postoperative care and pain relief. The nurse will determine the best pain assessment tool by observing the child's: Standard Text: Select all that apply.

A)Language skills.
B)Understanding of the concept of more and less or otherwise has the ability to quantify pain.
C)Ability to sit for a ten minute evaluation.
D)Ability to perceive pain.
E)Ability to understand pain.

Accepted Answer

The answer of The nurse is caring for a four-year-old...

Question 18

During shift report, the night nurse reports that the child who is terminally ill has developed tolerance to the morphine that the child has been receiving. The oncoming nurse realizes that the child:&#10;A)Is physically dependent on morphine.&#10;B)Is addicted to morphine.&#10;C)Is showing physical signs of withdrawal.&#10;D)Will need more medication to achieve the same effect.&#10;

Accepted Answer

The answer of During shift report, the night nurse reports...

Question 19

A five-year-old is hospitalized with a fractured femur. Which assessment tool is appropriate for this child?&#10;A)CRIES Scale&#10;B)Faces Pain Rating Scale&#10;C)SUN Scale&#10;D)PIPP Scale&#10;

Accepted Answer

The answer of A five-year-old is hospitalized with a fractured...

Question 20

A six-year-old postoperative patient IV has infiltrated and has to be restarted immediately for medication. There is no time for placing local anesthetic cream on the skin. What other complementary therapies would be most helpful when placing this IV?

A)Restraints
B)Moderate sedation
C)Anesthesia
D)Distraction

Accepted Answer

The answer of A six-year-old postoperative patient IV has infiltrated...

Question 21

In responding to the needs of pediatric patients in pain, the nurse has numerous nonpharmacologic interventions available. These interventions include: Standard Text: Select all that apply.&#10;A)Regional nerve block.&#10;B)Cutaneous stimulation.&#10;C)Application of heat.&#10;D)Electroanalgesia.&#10;E)Use of EMLA cream.&#10;

Accepted Answer

The answer of In responding to the needs of pediatric...

Deck 21: Pain Assessment and Management