Question 1

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,with morphine being the drug of choice for PCA.Parenteral use of codeine is not recommended.Methadone is not available in parenteral form in Canada.Meperidine is not used for continuous and extended pain relief.

Question 2

Which statement represents accurate information about the physiological assessment of children's pain?&#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

Physiological manifestations of pain may vary considerably and do not provide 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 individuals with persistent pain the body adapts,and these signs decrease or stabilize.These signs are of limited value and must be viewed in the context of a pain-rating scale,behavioural assessment,and parental report.When the child states that pain exists,it does.

Question 3

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.What is the most appropriate action for the nurse?

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

Administer naloxone (Narcan).

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 4

A lumbar puncture is needed on a school-age child.Which medication is the most appropriate to apply to provide analgesia during this procedure?&#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 anaesthetics (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 punctures.TAC provides skin anaesthesia 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 5

Which is true about nonpharmacological strategies for pain management?&#10;A) They may reduce pain perception.&#10;B) They make pharmacological strategies unnecessary.&#10;C) They usually take too long to implement.&#10;D) They trick children into believing they do not have pain.

Accepted Answer

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

Question 6

Which would the nurse identify as being an adverse effect when assessing a child who is receiving an opioid for pain management? Select all that apply.Express answer with small letters followed by a comma and a space-e.g. ,a,b,c

A) Diarrhea
B) Agitation
C) Pruritus
D) Miosis
E) Lacrimation
F) Anorexia
G) Nausea and vomiting

Accepted Answer

Agitation,pruritus,miosis and nausea and vomiting are all possible signs of adverse effects of opioids.Constipation,not diarrhea,is another adverse effect.Lacrimation and anorexia are signs of withdrawal in patients with a physical dependence on opioid.

Deck 34: Pain Assessment and Management