Deck 5: Pain Assessment and Management in Children

Question 1

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?

A) "We will allow the child to miss school if a headache occurs."
B) "We will respond matter-of-factly to requests for special attention."
C) "We will be sure to give much attention to our child when a headache occurs."
D) "We will be sure our child doesn't have to perform at a band concert if a headache occurs."

Answer 1

"We will respond matter-of-factly to requests for special attention."

Question 2

What describes nonpharmacologic techniques for pain management?

A) They may reduce pain perception.
B) They usually take too long to implement.
C) They make pharmacologic strategies unnecessary.
D) They trick children into believing they do not have pain.

Answer 2

They may reduce pain perception.

Question 3

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

A) Atelectasis
B) Hypoglycemia
C) Decrease in heart rate
D) Increase in cardiac output

Answer 3

Atelectasis

Question 4

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?

A) Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli.
B) The risks accompanying anesthesia and analgesia are too great to justify any possible benefit of pain relief.
C) Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences.
D) Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.

Question 5

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

A) Codeine sulfate (Codeine)
B) Morphine (Roxanol)
C) Methadone (Dolophine)
D) Meperidine (Demerol)

Question 6

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?

A) Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure.
B) Use a combination of fentanyl and midazolam for conscious sedation.
C) Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure.
D) Apply a transdermal fentanyl (Duragesic) "patch" immediately before the procedure.

Question 7

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

A) "No hurt."
B) "Red pain."
C) "Zero hurt."
D) "Least pain."

Question 8

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?

A) 15 minutes until maximum effect
B) 30 minutes until maximum effect
C) 1 hour until maximum effect
D) 1 1/2 hours until maximum effect

Question 9

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

A) Self-report
B) Behavioral
C) Physiologic
D) Parental report

Question 10

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

A) Children color the face with the color they choose to best describe their pain.
B) The scale can be used with most children as young as 3 years.
C) The scale is not appropriate for use with adolescents.
D) The FACES scale is useful in pain assessment but is not as accurate as physiologic responses.

Question 11

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?

A) The child will continue to sleep and be pain free.
B) Parents cannot administer additional medication with the button.
C) The pump can deliver baseline and bolus dosages.
D) There is a high risk of overdose, so monitoring is done every 15 minutes.

Question 12

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?

A) "With minimal sedation, the patient's respiratory efforts are affected, and cognitive function is not impaired."
B) "With general anesthesia, the patient's airway cannot be maintained, but cardiovascular function is maintained."
C) "During deep sedation, the patient can be easily aroused by loud verbal commands and tactile stimulation."
D) "During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation."

Question 13

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

A) Euphoria
B) Diuresis
C) Constipation
D) Allergic reactions

Question 14

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

A) Lorazepam (Ativan)
B) Gabapentin (Neurontin)
C) Hydromorphone (Dilaudid)
D) Morphine sulfate (MS Contin)

Question 15

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

A) Tactile stimulation
B) Commercial warm packs
C) Doing procedure during infant sleep
D) Oral sucrose and nonnutritive sucking

Question 16

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?

A) Give only an opioid analgesic at this time.
B) Increase dosage of analgesic until the child is adequately sedated.
C) Plan a preventive schedule of pain medication around the clock.
D) Give the child a clock and explain when she or he can have pain medications.

Question 17

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

A) Less expensive than oral medications
B) Produces a first-pass effect through the liver
C) Does not need to be administered frequently
D) Provides most rapid onset of effect, usually in about 5 minutes

Question 18

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?

A) Administer naloxone (Narcan).
B) Discontinue the 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.

Question 19

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?

A) They may react to painful stimuli but are unable to remember the pain experience.
B) They perceive and react to pain in much the same manner as children and adults.
C) They do not have the cortical and subcortical centers that are needed for pain perception.
D) They lack neurochemical systems associated with pain transmission and modulation.

Question 20

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

A) Lorazepam (Ativan)
B) Oxycodone (OxyContin)
C) Fentanyl (Sublimaze)
D) Morphine Sulfate (Morphine)

Question 21

MATCHING
Complementary and alternative medicine therapies are grouped into five classes. Match the complementary or alternative therapy to its classification.

Mind-body technique

A)Vitamins
B)Massage
C)Reiki
D)Hypnosis
E)Homeopathy

Question 22

MATCHING
Complementary and alternative medicine therapies are grouped into five classes. Match the complementary or alternative therapy to its classification.

Alternative medical system

A)Vitamins
B)Massage
C)Reiki
D)Hypnosis
E)Homeopathy

Question 23

A child receiving chemotherapy is experiencing mucositis. Which prescriptions should the nurse plan to administer for initial treatment? (Select all that apply.)

A) Scope mouth rinse
B) Listerine antiseptic mouth rinse
C) Carafate suspension (Sucralfate)
D) Nystatin oral suspension (Nystatin)
E) Lidocaine viscous (Lidocaine hydrochloride solution)

Question 24

MATCHING
Complementary and alternative medicine therapies are grouped into five classes. Match the complementary or alternative therapy to its classification.

Energy based

A)Vitamins
B)Massage
C)Reiki
D)Hypnosis
E)Homeopathy

Question 25

A health care provider prescribes Kytril (granisetron), 10 mcg/kg IV every 4 to 6 hours as needed for nausea. The medication label states: "Kytril 100 mcg/1 mL." The child weighs 15 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.
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Question 26

A health care provider prescribes naproxen (Naprosyn), 7 mg/kg PO every 12 hours for pain. The child weighs 25 kg. The medication label states: "Naproxen 125 mg/5 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.
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Question 27

A health care provider prescribes choline magnesium trisalicylate (Trilisate), 15 mg/kg PO every 8 to 12 hours as needed for pain. The child weighs 10 kg. The medication label states: "Choline magnesium trisalicylate 500 mg/5 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.
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Question 28

A health care provider prescribes acetaminophen (Tylenol) gtt, 10 mg/kg/dose PO every 4 to 6 hours as needed for pain. The infant weighs 8 kg. The medication label states: "Acetaminophen 80 mg/0.8 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place.
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Question 29

MATCHING
Complementary and alternative medicine therapies are grouped into five classes. Match the complementary or alternative therapy to its classification.

Manipulative treatment

A)Vitamins
B)Massage
C)Reiki
D)Hypnosis
E)Homeopathy

Question 30

A health care provider prescribes promethazine (Phenergan), 9 mg IV every 6 to 8 hours as needed for pruritus. The medication label states: "Promethazine 25 mg/1 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using two decimal places.
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Question 31

Which are components of the FLACC scale? (Select all that apply.)

A) Color
B) Capillary refill time
C) Leg position
D) Facial expression
E) Activity

Question 32

A health care provider prescribes OxyContin (oxycodone), 3 mg PO every 4 to 6 hours as needed for pain. The medication label states: "OxyContin 5 mg/1 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.
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Question 33

A health care provider prescribes haloperidol (Haldol), 0.15 mg/kg IV every 4 to 6 hours as needed for confusion. The medication label states: "Haloperidol 2 mg/1 mL." The child weighs 30 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer rounding to one decimal place.
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Question 34

Which coanalgesics should the nurse expect to be prescribed for pruritus? (Select all that apply.)

A) Naloxone (Narcan)
B) Inapsine (Droperidol)
C) Hydroxyzine (Atarax)
D) Promethazine (Phenergan)
E) Diphenhydramine (Benadryl)

Question 35

The nurse is using the CRIES pain assessment tool on a preterm infant in the neonatal intensive care unit. Which are the components of this tool? (Select all that apply.)

A) Color
B) Moro reflex
C) Oxygen saturation
D) Posture of arms and legs
E) Sleeplessness
F) Facial expression

Question 36

A health care provider prescribes hydroxyzine (Atarax), 0.6 mg/kg PO every 4 to 6 hours as needed for pruritus. The medication label states: "Hydroxyzine 10 mg/5 mL." The child weighs 20 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.
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Question 37

A health care provider prescribes ibuprofen (Motrin), 5 mg/kg PO every 6 to 8 hours as needed for pain. The child weighs 8 kg. The medication label states: "Ibuprofen 100 mg/5 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.
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Question 38

A health care provider prescribes diphenhydramine (Benadryl), 1 mg/kg PO every 4 to 6 hours as needed for pruritus. The child weighs 10 kg. The medication label states: "Diphenhydramine 12.5 mg/5 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.
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Question 39

A child receiving morphine sulfate (Morphine) is experiencing respiratory depression. A health care provider prescribes naloxone (Narcan), 0.5 mcg/kg IV in 2-minute increments until breathing improves. The medication label states: "Naloxone 400 mcg/1 mL." The child weighs 40 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using two decimal places.
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Question 40

MATCHING
Complementary and alternative medicine therapies are grouped into five classes. Match the complementary or alternative therapy to its classification.

Biologically based

A)Vitamins
B)Massage
C)Reiki
D)Hypnosis
E)Homeopathy