Question 1

The primary care pediatric nurse practitioner is preparing to perform a painful
procedure on a 4monthold infant. Besides providing local anesthesia, what other pain control method provides analgesic effects?
A. Providing toys
B. Singing or music
C. Sucrose solution
D. Swaddling or cuddling

Sucrose solution

Accepted Answer

Sucrose solution has been shown to provide analgesic effects in infants during painful procedures. Providing toys, singing or music, and swaddling or cuddling may provide comfort and distraction, but they do not have the same analgesic effects as sucrose solution.

Question 2

What is the most important dose&#173;limiting factor when prescribing acetaminophen with hydrocodone?&#10;A. Acetaminophen dose&#10;B. Gastrointestinal side effects&#10;C. Pruritis symptoms&#10;D. Urinary retention

Accepted Answer

Acetaminophen dose is the most important dose-limiting factor when prescribing acetaminophen with hydrocodone. This is because acetaminophen has a narrow therapeutic index, and high doses can lead to liver damage and other adverse effects. It is important to monitor the total daily dose of acetaminophen and to avoid exceeding the recommended maximum dose of 4 grams per day.

Question 3

An adolescent female reports moderate dysmenorrhea with periods and tells
the primary care pediatric nurse practitioner that 400 mg ibuprofen every 6 to 8 hours doesn't completely control her pain. What will the nurse practitioner recommend?
A. Increasing the ibuprofen dose to 600 to 800 mg every 6 to 8 hours
B. Taking extrastrength acetaminophen 1000 mg every 4 to 6 hours
C. Taking naproxen 500 mg initially and then 250 mg every 6 to 8 hours
D. Using extendedrelease naproxen 500 mg every 12 hours

Accepted Answer

Naproxen is an NSAID that is effective in managing dysmenorrhea. Starting with a higher initial dose of 500 mg followed by a lower dose of 250 mg every 6 to 8 hours may provide better pain relief than ibuprofen alone. Acetaminophen alone is not as effective in managing dysmenorrhea, and increasing the dose of ibuprofen beyond 400 mg may increase the risk of side effects without providing additional pain relief. Extended-release naproxen may be more convenient for some patients, but it is not necessary in this case as the patient is experiencing moderate pain and can manage it with the recommended dosing schedule.

Question 4

The parent of a school&#173;age child with a chronic pain condition tells the&#10;primary care pediatric nurse practitioner that the child has requested to stay home from school more often in the past few months. The child's exam does not reveal any significant change in pathology, and a review of the child's medications indicates appropriate dosing of analgesic medications. What will the nurse practitioner recommend?&#10;A. Assessing the child's pain every day to determine changes&#10;B. Ensuring the child stays quiet in bed with videos when having pain&#10;C. Having the child do homework when staying home from school&#10;D. Requiring the child to go to school even during pain episodes

Accepted Answer

The answer of The parent of a school&#173;age child with...

Question 5

A 4&#173;year&#173;old child has just been released from the hospital after orthopedic&#10;surgery on one leg following a bicycle accident. The child is sitting quietly on the exam table. When asked to rate pain, the child points to the &#34;1&#34; on a faces rating pain scale. What will the primary care pediatric nurse practitioner do next?&#10;A. Assess the child's vital signs and ability to walk without pain.&#10;B. Refill the prescription for a narcotic analgesic medication.&#10;C. Suggest that the parents give acetaminophen for mild pain.&#10;D. Teach the parent to give analgesics based on the child's report of pain.

Accepted Answer

The primary care pediatric nurse practitioner should assess the child's vital signs and ability to walk without pain as the child may not be accurately reporting the level of pain they are experiencing. Additionally, the nurse practitioner should conduct a physical examination of the surgical site to ensure there are no signs of infection or other complications. Refilling a prescription for a narcotic analgesic medication is not necessary at this time as the child is reporting a low level of pain. Suggesting acetaminophen for mild pain may be appropriate, but it is important to first assess the child's condition and teach the parent to give analgesics based on the child's report of pain after assessing the child's condition.

Question 6

An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant
(TCA) to treat phantom limb pain and reports that the medications are no longer effective. What will the primary care pediatric nurse practitioner do?
A. Change the TCA to a selective serotonin reuptake inhibitor.
B. Evaluate the adolescent for drugseeking behavior.
C. Increase the TCA dose and reevaluate in 2 to 3 weeks.
D. Refer the adolescent to a pain management specialist.

Accepted Answer

Since the medications are no longer effective, it is important to refer the adolescent to a pain management specialist for further evaluation and management. It is possible that the pain may require a multidisciplinary approach that is beyond the scope of primary care. Changing the TCA or increasing the dose may also not be effective and could potentially increase the risk of adverse effects. Evaluating for drug-seeking behavior is important but should not be the primary approach to managing the pain.

Question 7

A 3&#173;year&#173;old child is recovering from injuries sustained in a motor vehicle&#10;accident. How will the primary care pediatric nurse practitioner evaluate this child's pain?&#10;A. Ask the child to rate pain intensity on a 4&#173; to 5&#173;item pain discrimination scale.&#10;B. Have the child describe any pain as &#34;no pain, a little pain, or a lot of pain.&#34;&#10;C. Question the child about the intensity and specific location of any pain.&#10;D. Rely on nonverbal responses such as facial expressions and limb movements.

Accepted Answer

The answer of A 3&#173;year&#173;old child is recovering from injuries...

Question 8

A developmentally and cognitively disabled 10yearold child who is unable to
communicate must undergo a series of surgeries, and the child's parent asks how to know if the child is in pain and when to give pain medication. What will the primary care pediatric nurse practitioner teach this parent to use to assess this child's pain?
A. Comfort scale
B. FLACC scale
C. NCCPCR
D. Nonverbal observations

Accepted Answer

The answer of A developmentally and cognitively disabled 10&#173;year&#173;old child...

Question 9

The primary care pediatric nurse practitioner is evaluating a 10yearold child
who is describing shooting pain in both legs associated with aching, tingling, and burning. The child is unable to pinpoint specific locations for this pain. Which type of pain does the nurse practitioner suspect?
A. Chronic pain
B. Neuropathic pain
C. Somatic pain
D. Visceral pain

Accepted Answer

The description of shooting pain, aching, tingling, and burning with inability to pinpoint specific locations suggests neuropathic pain, which is caused by dysfunction or damage to the nervous system. Chronic pain is pain that persists for more than three months, somatic pain is caused by stimulation of pain receptors in body tissues, and visceral pain originates from internal organs.

Deck 23: Pediatric Pain Management