Question 1

The nurse is teaching a staff development program about levels of sedation in the pediatric population.Which statement by one of the participants should indicate a correct understanding of the teaching?

Accepted Answer

When discussing levels of sedation,the participants should understand that during moderate sedation,the patient responds to verbal commands but may not respond to light tactile stimulation,cognitive function is impaired,and respiratory function is adequate.In minimal sedation,the patient responds to verbal commands and may have impaired cognitive function; the respiratory and cardiovascular systems are unaffected.In deep sedation,the patient cannot be easily aroused except by painful stimuli; the airway and spontaneous ventilation may be impaired,but cardiovascular function is maintained.With general anesthesia,the patient loses consciousness and cannot be aroused with painful stimuli,the airway cannot be maintained,and ventilation is impaired; cardiovascular function may or may not be impaired.

Question 2

A 6-year-old child has patient-controlled analgesia (PCA)for pain management after orthopedic surgery.The parents are worried that their child will be in pain.What should your explanation to the parents include?

Accepted Answer

The PCA prescription can be set for a basal rate for a continuous infusion of pain medication.Additional doses can be administered by the patient,parent,or nurse as necessary.Although the goal of PCA is to have effective pain relief,a pain-free state may not be possible.With a 6-year-old child,the parents and nurse must assess the child to ensure that adequate medication is being given because the child may not understand the concept of pushing a button.Evidence-based practice suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary.The prescription for the PCA includes how much medication can be given in a defined period.Monitoring every 1 to 2 hours for patient response is sufficient.

Question 3

What is a significant common side effect that occurs with opioid administration?

Accepted Answer

Constipation is one of the most common side effects of opioid administration.Preventive strategies should be implemented to minimize this problem.Sedation is a more common result than euphoria.Urinary retention,not diuresis,may occur with opiates.Rarely,some individuals may have pruritus.

Question 4

Which drug is usually the best choice for patient-controlled analgesia (PCA)for a child in the immediate postoperative period?

Accepted Answer

The most commonly prescribed medications for PCA are morphine,hydromorphone,and fentanyl.Parenteral use of codeine is not recommended.Methadone in parenteral form is not used in a PCA but is given orally or intravenously for pain in the infant.Meperidine is not used for continuous and extended pain relief.

Question 5

Children as young as age 3 years can use facial scales for discrimination.What are some suggested anchor words for the preschool age group?

Accepted Answer

"No hurt" is a phrase that is simple,concrete,and appropriate to the preoperational stage of the child.Using color is complicated for this age group.The child needs to identify colors and pain levels and then choose an appropriate symbolic color.This is appropriate for an older child.Zero is an abstract construct not appropriate for this age group."Least pain" is less concrete than "no hurt."

Question 6

A preterm infant has just been admitted to the neonatal intensive care unit.The infant's parents ask the nurse about anesthesia and analgesia when painful procedures are necessary.What should the nurse's explanation be?

Accepted Answer

Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.Painful stimuli cause a global stress response,including cardiorespiratory changes,palmar sweating,increased intracranial pressure,and hormonal and metabolic changes.Adequate analgesia and anesthesia are necessary to decrease the stress response.The pathways are sufficiently myelinated to transmit the painful stimuli and produce the pain response.Local and systemic pharmacologic agents are available to permit anesthesia and analgesia for neonates.

Question 7

A burn patient is experiencing anxiety over dressing changes.Which prescription should the nurse expect to be ordered to control anxiety?

Accepted Answer

A benzodiazepine such as lorazepam is prescribed as an antianxiety agent.Oxycodone,fentanyl,and morphine sulfate are opioid analgesics.

Question 8

Which is the most consistent and commonly used data for assessment of pain in infants?

Accepted Answer

Behavioral assessment is useful for measuring pain in young children and preverbal children who do not have the language skills to communicate that they are in pain.Infants are not able to self-report.Physiologic measures are not able to distinguish between physical responses to pain and other forms of stress.Parental report without a structured tool may not accurately reflect the degree of discomfort.

Question 9

The nurse is planning pain control for a child.Which is the advantage of administering pain medication by the intravenous (IV)bolus route?

Accepted Answer

The advantage of pain medication by the IV bolus route is that it provides the most rapid onset of effect,usually in about 5 minutes.IV medications are more expensive than oral medications,and the IV route bypasses the first-pass effect through the liver.Pain control with IV bolus medication needs to be repeated hourly for continuous pain control.

Question 10

A child is in the intensive care unit after a motor vehicle collision.The child has numerous fractures and is in pain that is rated 9 or 10 on a 10-point scale.In planning care,the nurse recognizes that the indicated action is which?

Accepted Answer

For severe postoperative pain,a preventive around the clock (ATC)schedule is necessary to prevent decreased plasma levels of medications.The opioid analgesic will help for the present,but it is not an effective strategy.Increasing the dosage requires an order.The nurse should give the drug on a regular schedule and evaluate the effectiveness.Using a clock is counterproductive because it focuses the child's attention on how long he or she will need to wait for pain relief.

Question 11

The nurse is caring for a child receiving a continuous intravenous (IV)low-dose infusion of 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 do which first?

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,then 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 12

A cancer patient is experiencing neuropathic cancer pain.Which prescription should the nurse expect to be ordered to control anxiety?

Accepted Answer

Anticonvulsants (gabapentin,carbamazepine)have demonstrated effectiveness in neuropathic cancer pain.Ativan is an antianxiety agent,and Dilaudid and MS Contin are opioid analgesics.

Question 13

What describes nonpharmacologic techniques for pain management?

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.The nonpharmacologic strategy should be matched with the child's pain severity and be taught to the child before the onset of the painful experience.Tricking children into believing they do not have pain may mitigate the child's experience with mild pain,but the child will still know the discomfort was present.

Question 14

The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures.The nurse's response should be based on which characteristic about preterm infants' pain?

Accepted Answer

Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults.Preterm infants can have significant reactions to painful stimuli.Pain can cause oxygen desaturation and global stress response.These physiologic effects must be avoided by use of appropriate analgesia.Painful stimuli cause a global stress response,including cardiorespiratory changes,palmar sweating,increased intracranial pressure,and hormonal and metabolic changes.Adequate analgesia and anesthesia are necessary to decrease the stress response.

Question 15

What is an important consideration when using the FACES pain rating scale with children?

Accepted Answer

The FACES scale is validated for use with children ages 3 years and older.Children point to the face that best describes their level of pain.The scale can be used through adulthood.The child's estimate of the pain should be used.The physiologic measures may not reflect more long-term pain.

Question 16

The nurse is teaching the parents of a child with recurrent headaches methods to modify behavior patterns that increase the risk of headache.Which statement by the parents indicates understanding the teaching?

Accepted Answer

To modify behavior patterns that increase the risk of headache or reinforce headache activity,the nurse instructs the parents to avoid giving excessive attention to their child's headache and to respond matter-of-factly to pain behavior and requests for special attention.Parents learn to assess whether the child is avoiding school or social performance demands because of headache.

Question 17

A bone marrow aspiration and biopsy are needed on a school-age child.The most appropriate action to provide analgesia during the procedure is which?

Accepted Answer

A bone marrow biopsy is a painful procedure.The combination of fentanyl and midazolam should be used to provide conscious sedation.TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin.The gel can be placed on a wound for suturing.It is not sufficient for a bone marrow biopsy.EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure.It eliminates or reduces the pain from most procedures involving skin puncture.For this procedure,systemic analgesia is required.Transdermal fentanyl patches are useful for continuous pain control,not rapid pain control.

Question 18

Which nonpharmacologic intervention appears to be effective in decreasing neonatal procedural pain?

Accepted Answer

Nonnutritive sucking attenuates behavioral,physiologic,and hormonal responses to pain.The addition of sucrose has been demonstrated to have calming and pain-relieving effects for neonates.Tactile stimulation has a variable effect on response to procedural pain.No evidence supports commercial warm packs as a pain control measure.With resulting increased blood flow to the area,pain may be greater.The infant should not be disturbed during the sleep cycle.It makes it more difficult for the infant to begin organization of sleep and awake cycles.

Question 19

Which is a complication that can occur after abdominal surgery if pain is not managed?

Accepted Answer

Pain associated with surgery in the abdominal region (e.g.,appendectomy,cholecystectomy,splenectomy)may result in pulmonary complications.Pain leads to decreased muscle movement in the thorax and abdominal area and leads to decreased tidal volume,vital capacity,functional residual capacity,and alveolar ventilation.The patient is unable to cough and clear secretions,and the risk for complications such as pneumonia and atelectasis is high.Severe postoperative pain also results in sympathetic overactivity,which leads to increases in heart rate,peripheral resistance,blood pressure,and cardiac output.Hypoglycemia,decreases in heart rate,and increases in cardiac output are not complications of poor pain management.

Question 20

The nurse is planning to administer a nonopioid for pain relief to a child.Which timing should the nurse plan so the nonopioid takes effect?

Accepted Answer

Nonsteroidal antiinflammatory drugs (NSAIDs)can provide safe and effective pain relief when dosed at appropriate levels with adequate frequency.Most NSAIDs take about 1 hour for effect,so timing is crucial.

Quiz 5: Pain Assessment and Management in Children