Question 1

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 drug-seeking behavior.
C) Increase the TCA dose and reevaluate in 2 to 3 weeks.
D) Refer the adolescent to a pain management specialist.

D

Accepted Answer

The lack of effectiveness of the current medications and the complexity of managing phantom limb pain in an adolescent suggest the need for referral to a pain management specialist. Changing the TCA to a selective serotonin reuptake inhibitor may not be appropriate without further evaluation, and increasing the TCA dose without reevaluation may not address the underlying issue. The evaluation for drug-seeking behavior may be appropriate in certain cases, but should not be the primary focus in this patient.

Question 2

The primary care pediatric nurse practitioner is preparing to perform a painful procedure on a 4-month-old 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

C

Accepted Answer

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

Question 3

A 3-year-old child is recovering from injuries sustained in a motor vehicle 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- to 5-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

B

Question 4

The parent of a school-age child with a chronic pain condition tells the 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?

A) Assessing the child's pain every day to determine changes
B) Ensuring the child stays quiet in bed with videos when having pain
C) Having the child do homework when staying home from school
D) Requiring the child to go to school even during pain episodes

Accepted Answer

The answer of The parent of a school-age child with...

Question 5

A 4-year-old child has just been released from the hospital after orthopedic 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 "1" on a faces rating pain scale. What will the primary care pediatric nurse practitioner do next?

A) Assess the child's vital signs and ability to walk without pain.
B) Refill the prescription for a narcotic analgesic medication.
C) Suggest that the parents give acetaminophen for mild pain.
D) Teach the parent to give analgesics based on the child's report of pain.

Accepted Answer

Even though the child points to a "1" on the pain scale, it is important to assess vital signs and ability to walk without pain to ensure there are no complications from the surgery or underlying injuries. Pain medication may still be necessary, but assessment should come first.

Deck 28: Pediatric Pain and Fever Management