CHAPTER 18: PAIN MANAGEMENT My Nursing Test Banks

CHAPTER 18: PAIN MANAGEMENT

MULTIPLE CHOICE

1.When it comes to pain management in infants and children, the majority of health care professionals are still under the impression that infants and children:

a.

need one-half the pain medication that adults need

b.

need about the same amount of pain medication as adults, adjusted for their body weight

c.

do not have pain or suffer less pain than adults

d.

have a lot more pain than adults

ANS: C

Feedback

A

Incorrect: Pediatric clients have not been identified as needing one-half of the pain medication required by adults.

B

Incorrect: The concept of needing about the same amount of pain medication as adults adjusted for their body weight has not been identified.

C

Correct: Many health care professionals are under the impression that pediatric clients do not experience pain or are less sensitive to pain than adults.

D

Incorrect: It is not suggested that pediatric clients have more pain than adults.

PTS:1REF:p. 582 Pain Management

OBJ: Cognitive Level: Comprehension

2.Which of the following statements best describes acute pain?

a.

discomfort lasting 3 to 5 days and due to a specific cause such as surgery or injury

b.

discomfort that comes on suddenly and lasts less than 8 hours

c.

a sharp hurting in a specific location that comes and goes suddenly

d.

any hurting that is not considered long-lasting by the individual experiencing it

ANS: A

Feedback

A

Correct: Acute pain is characterized as generally lasting 3 to 5 days and is attributed to a specific cause such as surgery or an injury.

B

Incorrect: Acute pain is not characterized by coming on suddenly and lasting less than 8 hours.

C

Incorrect: Acute pain is not defined as a sharp hurting in a specific location

D

Incorrect: Acute pain is not defined as any hurting that is not perceived as being long lasting.

PTS:1REF:p. 582 Pain Management

OBJ: Cognitive Level: Comprehension

3.A mother tells the nurse that her child has experienced pain lasting for long periods of time with the pain coming and going. The nurse would describe this pain in her assessment as which of the following kinds of pain?

a.

acute pain

c.

strange pain

b.

moderate pain

d.

chronic pain

ANS: D

Feedback

A

Incorrect: Acute pain is described as pain lasting 3 to 5 days.

B

Incorrect: Moderate pain does not define intermittent pain that lasts for extended periods of time.

C

Incorrect: Strange is not a defining characteristic of pain.

D

Correct: Chronic pain is described as pain that lasts for long periods of time or comes and goes often over an extended period of time.

PTS:1REF:p. 582 Pain Management

OBJ: Cognitive Level: Comprehension

4.Nociceptors are best described as nerve receptors specific to which of the following?

a.

inflammation

c.

pressure

b.

pain

d.

sprain

ANS: B

Feedback

A

Incorrect: Nociceptors are not associated with inflammation.

B

Correct: Nociceptors are free nerve endings with specific pain receptors found in the tissues throughout the body.

C

Incorrect: Nociceptors are not associated with pressure.

D

Incorrect: Nociceptors are not associated with a sprain.

PTS:1REF:p. 582 Pain Management

OBJ: Cognitive Level: Comprehension

5.Which of the following factors has the most influence on how long pain lasts and how intense it is?

a.

the persons past experience with pain

b.

how much pain medication the person takes at one time

c.

the release of chemical mediators such as substance P

d.

the persons history of pain medication use and tolerance to medications

ANS: C

Feedback

A

Incorrect: The persons past experience with pain may affect how long pain lasts and how intense it is, but it is not the factor with most influence.

B

Incorrect: How much pain medication the person takes at one time has not been identified as a factor that influences how long pain lasts and how intense it is.

C

Correct: Substance P, a neuropeptide, sensitizes the nerve endings and increases the rate of firing. Thus, substance P is influential on how long pain lasts and the intensity of the pain experience.

D

Incorrect: The persons history of pain medication use and tolerance to medications has not been identified as a factor that influences how long pain lasts and how intense it is.

PTS:1REF:p. 582 Pain Management

OBJ: Cognitive Level: Comprehension

6.Which of the following theories is currently in use to explain how pain impulses travel and are interpreted in the body?

a.

classic gate control theory

c.

electrical impulse theory

b.

sodium ion theory

d.

hormonal rise theory

ANS: A

Feedback

A

Correct: The classic gate control theory attempts to explain how pain impulses travel and are experienced and interpreted by the body.

B

Incorrect: The sodium ion theory does not serve to explain how pain impulses travel and are interpreted by the body.

C

Incorrect: The electrical impulse theory does not serve to explain how pain impulses travel and are interpreted by the body.

D

Incorrect: The hormonal rise theory does not serve to explain how pain impulses travel and are interpreted by the body.

PTS:1REF:p. 583 Pain Physiology

OBJ: Cognitive Level: Comprehension

7.A number of research studies have shown that there is an improvement in postoperative morbidity and mortality then:

a.

alpha stimulation is applied for at least 30 minutes before and after surgery

b.

infants and children receive general anesthesia and postoperative pain management

c.

vitamin C is given to infants and children for a week before and a week after surgery

d.

fathers hold and touch their infants before and after surgery

ANS: B

Feedback

A

Incorrect: Alpha stimulation has not been attributed to improvement in postoperative morbidity and mortality.

B

Correct: Research studies have suggested that infants and children who receive general anesthesia and postoperative pain management demonstrate improvement in postoperative morbidity and mortality.

C

Incorrect: Vitamin C administration has not been attributed to improvement in postoperative morbidity and mortality.

D

Incorrect: Fathers holding and touching their infants before and after surgery has not been associated with improvement in morbidity and mortality.

PTS:1REF:p. 583 Pain Physiology

OBJ: Cognitive Level: Comprehension

8.As a nurse you must explore your beliefs about medication for infants and children because research has shown which of the following?

a.

Nurses are likely to over\-medicate and undermedicate children under their care.

b.

Nurses tend to believe that medication will harm children more than help them.

c.

It takes a lot of exploration of beliefs before a nurse can be consistent in the administration of pain medication regardless of race, gender, religion, or social status.

d.

Educational level, personal pain experience, and number of years in practice influence the nurse in the decision to medicate or not medicate a child in pain.

ANS: D

Feedback

A

Incorrect: Nurses are not thought to typically overmedicate and undermedicate children.

B

Incorrect: It is not indicated that nurses believe that medications will harm children more than help them.

C

Incorrect: The administration of pain medication is not thought to be dependent upon the exploration of the nurses beliefs before consistency is reached in the medicating of clients regardless of race, gender, religion, or social status. However, such factors may contribute to the clients request for pain management.

D

Correct: For the nurse, research suggests that the educational level, personal pain experience, and number of years in practice play a role in the decision to medicate or not medicate a child for pain.

PTS:1REF:p. 583 Pain Physiology

OBJ: Cognitive Level: Application

9.A general rule that nurses can use in deciding whether an intervention or procedure would hurt a child is to ask which of the following questions?

a.

Would this hurt an adult? If the answer is yes, then it would hurt a child.

b.

Ask the child: Do you think this will hurt a lot, some, or not at all?

c.

Ask the mother: Do you think this procedure or intervention will hurt your child?

d.

Has this child had this procedure or intervention in the past? If so, what was the pain history?

ANS: A

Feedback

A

Correct: Prior to performing an intervention or procedure, it is necessary for the nurse to consider the potential pain associated with the action. Because the pediatric client may be ineffective in communicating pain to the health care provider, it is essential for the nurse to anticipate painful experiences. The nurse can expect that a procedure that would hurt an adult will also cause pain to a child.

B

Incorrect: Asking the child would not consistently be effective, as the ability to predict pain may not be developmentally possible.

C

Incorrect: The nurse cannot assume that the parent will be familiar with the procedure and the outcomes associated with it

D

Incorrect: Regardless of past experience, the nurse can anticipate that an intervention or procedure that causes pain in an adult will also cause pain in the child.

PTS:1REF:p. 586 Child Development and Pain

OBJ: Cognitive Level: Application

10.Which of the following statements best describes the term tolerance?

a.

the ability to take a particular medication without feeling worse after taking it

b.

being able to take a medication even if it does have adverse side effects

c.

the need to use increasing doses of a medication over time to achieve the desired result

d.

putting up with taking various medications even then you do not feel they are necessary

ANS: C

Feedback

A

Incorrect: Tolerance is not described as the ability to take a particular medication without feeling worse after taking it.

B

Incorrect: Tolerance is not the ability to take a medication even if it does have adverse side effects.

C

Correct: Tolerance is the physical need for an increasing doses of a medication over time to achieve the desired result. The body adapts to the presence of the medication so the desired effect is lessened.

D

Incorrect: Tolerance is not described as putting up with taking various medications even then you do not feel they are necessary.

PTS:1REF:p. 584 Child Development and Pain

OBJ: Cognitive Level: Knowledge

11.When children experience pain it is:

a.

character building

b.

likely to interrupt sleep, appetite, and play

c.

only because they are not focusing on something else

d.

going to be of lesser duration and intensity than adults experience

ANS: B

Feedback

A

Incorrect: When children experience pain, it is not character building. This is a common pain misconception.

B

Correct: When children experience pain, it is likely to interrupt sleep, appetite, and play. However, many children play despite pain, because this is normal and helps distract them from their pain. Therefore, the child should be regularly assessed for pain and treated according to her or his pain rating.

C

Incorrect: It has not been demonstrated that children experience pain only because they are not focusing on something else.

D

Incorrect: Children as young as 26 weeks of age have intact afferent pathways for pain transmission and respond to tissue injury with the same chemical, behavioral, and physiologic signs as an adult.

PTS:1REF:p. 584 Child Development and Pain

OBJ: Cognitive Level: Comprehension

12.The nurse working with infants knows that infants have a unique response to pain, which is to exhibit which of the following behaviors?

a.

yawn several times over a couple of minutes

b.

claw at the air with their hands

c.

utter piercing cries and arch the back in an extreme way

d.

withdraw, cry, and have a furrowed brow and a taut tongue

ANS: D

Feedback

A

Incorrect: Infants have a unique response to pain which is not exhibited by behaviors such as yawning several times over a couple of minutes.

B

Incorrect: Infants have a unique response to pain which is not exhibited by behaviors such as clawing at the air with their hands.

C

Incorrect: Infants do not respond to pain by exhibiting utter piercing cries and arching the back in an extreme way. however, infants do have a distinctive cry in response to pain which is high-pitched and shrill.

D

Correct: Infants have a unique response to pain, which is to exhibit behaviors such as withdrawal from painful stimuli, cry, and have a furrowed brow and a taut tongue.

PTS:1REF:p. 584 Child Development and Pain

OBJ: Cognitive Level: Comprehension

13.When the preschooler is sitting still or lying still for a long time and not engaging in physical activity, the nurse will most suspect and assess for which of the following conditions?

a.

pain

c.

dizziness

b.

nausea

d.

boredom

ANS: A

Feedback

A

Correct: Lack of physical activity may indicate the preschooler is experiencing pain, because preschoolers, then healthy, are not capable of sitting still of lying still for long periods of time. The child of this age who does not readily run, jump, or wiggle may be in pain.

B

Incorrect: When the preschooler is sitting or lying still for a long time and not engaging in physical activity, the nurse will not first suspect and assess for nausea.

C

Incorrect: When the preschooler is sitting or lying still for a long time and not engaging in physical activity, the nurse will not first suspect and assess for dizziness.

D

Incorrect: When the preschooler is sitting or lying still for a long time and not engaging in physical activity, the nurse will not first suspect and assess for boredom.

PTS:1REF:p. 585 Child Development and Pain

OBJ: Cognitive Level: Comprehension

14.The nurse working with school-aged children realizes that children of this age have many body image concerns. Which of the following fears would most likely be a fear of hospitalized school-age children undergoing surgery?

a.

The medication will not be strong enough to take away pain.

b.

The nurse will spend too much time with them.

c.

Their insides will leak out after injections or surgery.

d.

Their classmates will get to have more fun and play more.

ANS: C

Feedback

A

Incorrect: Working with school-aged children, the nurse recognizes they may have preconceived ideas about pain and fears about surgery; but, the abstract thought that the medication will not be strong enough is not an issue for this age group.

B

Incorrect: Working with school-aged children, the nurse recognizes they may have preconceived ideas about pain and fears about surgery; but, the fear that the nurse will spend too much time with them is not an issue for this age group.

C

Correct: School-aged children have many body image concerns and some fear their insides will leak out after injections or surgery. Covering all wounds can decrease their anxiety and help decrease their pain perception.

D

Incorrect: Working with school-aged children, the nurse recognizes they may have preconceived ideas about pain and fears about surgery; but, the fear that their classmates will get to have more fun and play more is not an issue for this age group.

PTS:1REF:p. 586 Child Development and Pain

OBJ: Cognitive Level: Application

15.When giving the school-aged child an intramuscular injection, the nurse knows that it is most important to:

a.

kiss the area of the hurt

c.

say you are sorry for any hurt

b.

apply a self-adhesive bandage

d.

give the child a hug

ANS: B

Feedback

A

Incorrect: When giving the school-aged child an intramuscular injection, the nurse knows that it is not most important to kiss the area of the hurt.

B

Correct: When giving the school-aged child an intramuscular injection, the nurse knows that it is most important to apply a self-adhesive bandage to cover the opening so the child does not fear that their insides will be leaking out.

C

Incorrect: When giving the school-aged child an intramuscular injection, the nurse knows that it is not most important to say you are sorry for any hurt.

D

Incorrect: When giving the school-aged child an intramuscular injection, the nurse knows that it is not most important to give the child a hug.

PTS:1REF:p. 586 Child Development and Pain

OBJ: Cognitive Level: Application

16.The nurse is preparing to give the school-aged child an injection. If there are no contraindications, the nurses best course of action is to do which of the following?

a.

Ask a parent which site is preferred.

b.

Offer the child a choice of sites.

c.

Select a site without consulting anyone.

d.

Ask the outgoing shift nurse what site would be best.

ANS: B

Feedback

A

Incorrect: Preparing to give the school-aged child an injection, the nurses best course of action is not to ask a parent which site is preferred, ask the school-aged child.

B

Correct: School-aged children need to gain some control over their environment and should be offered choices whenever possible. Allowing a child to choose the limb for the injection site would be a key example.

C

Incorrect: Preparing to give the school-aged child an injection, the nurses best course of action is not to select a site without consulting anyone, consult the school-aged child.

D

Incorrect: Preparing to give the school-aged child an injection, the nurses best course of action is not to ask the outgoing shift nurse what site would be best, offer the choice to the school-aged child.

PTS:1REF:p. 586 Child Development and Pain

OBJ: Cognitive Level: Application

17.The nurse working with hospitalized adolescents realizes that frequent assessment of the adolescents pain level is necessary because adolescents tend to:

a.

complain a lot and overrate their pain

b.

deny their pain and hide it from caregivers

c.

get busy and forget they have pain

d.

not want to talk to the nurse about anything

ANS: B

Feedback

A

Incorrect: Working with hospitalized adolescents, the nurse realizes that frequent assessment of the adolescents pain level is necessary because adolescents tend to hide their pain, not because they complain a lot and overrate their pain.

B

Correct: Adolescents may feel they need to hide their pain (grin and bear it), and hesitate to report pain if they think everything is already being done to relieve it. Frequently, they deny pain to prove strength or in hopes of a quicker discharge from the hospital.

C

Incorrect: Working with hospitalized adolescents, the nurse realizes that frequent assessment of the adolescents pain level is necessary because adolescents tend to hide their pain, not because they get busy and forget they have pain.

D

Incorrect: Working with hospitalized adolescents, the nurse realizes that frequent assessment of the adolescents pain level is necessary because adolescents tend to hide their pain, not because they dont want to talk to the nurse about anything.

PTS:1REF:p. 586 Child Development and Pain

OBJ: Cognitive Level: Application

18.The nurse knows that then hospitalized adolescents underrate their pain and hide it, the adolescent is most likely denying pain to:

a.

show strength or get out of the hospital earlier

b.

get the nursing staff in trouble with the doctor

c.

keep from getting cut off from phoning friends

d.

avoid having to take pain medication of any type

ANS: A

Feedback

A

Correct: The nurse knows that then hospitalized adolescents underrate their pain and hide it, the adolescent is most likely denying pain to show strength or get out of the hospital earlier.

B

Incorrect: The nurse knows that then hospitalized adolescents underrate their pain and hide it, the adolescent is most likely denying pain to get the nursing staff in trouble with the doctor.

C

Incorrect: The nurse knows that then hospitalized adolescents underrate their pain and hide it, the adolescent is most likely denying pain to keep from getting cut off from phoning friends.

D

Incorrect: The nurse knows that then hospitalized adolescents underrate their pain and hide it, the adolescent is not most likely denying pain to avoid having to take pain medication of any type. Although some worry about the potential for addiction, most hide pain to show how adult they are (strong) or to shorten the hospital stay.

PTS:1REF:p. 586 Child Development and Pain

OBJ: Cognitive Level: Comprehension

19.As part of the pain assessment of an adolescent, the nurse will most likely ask which of the following questions?

a.

Have you ever faked pain to get attention from the nurses or your parents?

b.

What is your favorite street drug for dealing with psychological or physical pain?

c.

Do you think your parents or caregivers take too much medication for pain?

d.

What kind of pain have you had in the past and what helped make it decrease or stop?

ANS: D

Feedback

A

Incorrect: Pain history questions for children do not include asking about faking pain.

B

Incorrect: Pain history questions for children do not include asking about illicit drugs.

C

Incorrect: Pain history questions for children do not include asking about pain medications taken by the parents or caregivers, especially a judgment question.

D

Correct: Pain history questions for children include asking about times you have hurt before today and what helps the most to take the pain away.

PTS:1REF:p. 587 Pain Assessment

OBJ: Cognitive Level: Application

20.Who is the best person to provide the most accurate measurement of a childs pain?

a.

the child him- or herself

b.

the mother of the child

c.

the father or a caregiver other than the mother

d.

the primary nurse

ANS: A

Feedback

A

Correct: In all types of pain, the most information can be gained then children measure the pain themselves. Several methods assist children in rating their own pain. The choice of a specific measure should be based on the childs developmental level and preferences, institutional policies and instrumental quality.

B

Incorrect: The mother of the child is not the best person to provide the most accurate measurement of a childs pain.

C

Incorrect: The father or a caregiver other than the mother is not the best person to provide the most accurate measurement of a childs pain.

D

Incorrect: The primary nurse is not the best person to provide the most accurate measurement of a childs pain.

PTS:1REF:p. 587 Pain Assessment

OBJ: Cognitive Level: Comprehension

21.The PQRST pain assessment measures:

a.

past quick responses to stimulation of tough pain

b.

presence, quality, radiation or location, severity, and timing of pain

c.

the type of pain: pinlike, quiet or dull, radiant, stinging, and tolerable

d.

clients quality rating of strength and tolerability of pain level

ANS: B

Feedback

A

Incorrect: The PQRST pain assessment does not measure past quick responses to stimulation of tough pain.

B

Correct: The PQRST pain assessment measures: presence of pain; qualiy of pain; radiation or location of pain; severity of pain (0-10); and, timing of the pain.

C

Incorrect: The PQRST pain assessment does not measure the type of pain: pin\-like, quiet or dull, radiant, stinging, and tolerable.

D

Incorrect: The PQRST pain assessment does not measure the clients quality rating of strength and tolerability of pain level.

PTS:1REF:p. 587 Pain Assessment

OBJ: Cognitive Level: Comprehension

22.The Wong-Baker method for assessing pain in children uses:

a.

a system of six different colors for ranking pain from red hot to none in cool shades of blue on a rating scale of 5 to 0

b.

six different faces ranging from smiling to very distressed with downturned mouth and severe frown on a rating scale of 0 to 5

c.

pictures of children in various activities from playing happily to crying over a scraped knee

d.

a play kit with dolls who show various expressions including three who have expressions of mild, moderate, and severe pain

ANS: B

Feedback

A

Incorrect: The Wong-Baker method for assessing pain in children does not use a system of six different colors for ranking pain.

B

Correct: The Wong-Baker method for assessing pain in children uses six different faces ranging from smiling to very distressed with downturned mouth and severe frown on a rating scale of 0 to 5. It helps children express their level of pain by pointing to a cartoon face that most closely resembles how they are feeling.

C

Incorrect: The Wong-Baker method for assessing pain in children does not use pictures of children in various activities.

D

Incorrect: The Wong-Baker method for assessing pain in children does not use a play kit with dolls.

PTS:1REF:p. 588 Pain Assessment

OBJ: Cognitive Level: Comprehension

23.The Oucher pain assessment tool is for use with children of ages:

a.

1 to 2 years

c.

12 to 14 years

b.

3 to 12 years

d.

15 to 18 years

ANS: B

Feedback

A

Incorrect: The Oucher pain assessment tool is not for use with children of ages 1 to 2 years, as it is numeric and uses photos of children in pain.

B

Correct: The Oucher pain assessment tool is for use with children of ages 3 to 12 years. The Oucher pediatric pain intensity scale consists of two scales: a 0 to 100 numeric scale and a 6-point facial scale. If the child can count, the numeric scale can be used. The facial scale can be successfully used in children as young as 3 to 4 years.

C

Incorrect: The Oucher pain assessment tool is not for use with children above the age of 12, the Adolescent and Pediatric Pain Tool (APPT) is more appropriate.

D

Incorrect: The Oucher pain assessment tool is not for use with children above the age of 12, the Adolescent and Pediatric Pain Tool (APPT) is more appropriate.

PTS: 1 REF: p. 590 Pain Assessment OBJ: Cognitive Level: Knowledge

24.The Oucher pain assessment tool uses a numeric scale ranking pain from:

a.

0 to 100

c.

1 to 10

b.

1 to 5

d.

0 to 20

ANS: A

Feedback

A

Correct: The Oucher pain assessment tool uses a numeric scale ranking pain from 0 to 100 with a 6-point facial scale. If the child can count from 1 to 100 by ones or by tens, the numeric scale can be used.

B

Incorrect: The Oucher pain assessment tool does not use a numeric scale ranking pain from 1 to 5.

C

Incorrect: The Oucher pain assessment tool does not use a numeric scale ranking pain from 1 to 10.

D

Incorrect: The Oucher pain assessment tool does not use a numeric scale ranking pain from 0 to 20.

PTS: 1 REF: p. 590 Pain Assessment OBJ: Cognitive Level: Knowledge

25.The nurse has asked a child to rate her pain on a scale of 0 to 10. The child ranks the pain at a 5. The nurse will chart this in which of the following ways?

a.

ranks pain at a 5

c.

admits to a moderate level of pain

b.

states pain is at a 5 on a 10-point scale

d.

midpoint of scale in terms of pain

ANS: B

Feedback

A

Incorrect: The scale points should be documented then recording the childs measure of pain (i.e., rates pain 5 out of 10 rather than rates pain a 5).

B

Correct: For the verbal child, the pain assessment scale of 0 to 10 or 0 to 5 may be the simplest and best understood. Here the nurse asks the child to rate pain on a scale there zero is no pain and the higher number is the worst pain you can imagine. The scale points should be documented then recording the childs measure of pain (i.e., rates pain 5 out of 10 rather than rates pain a 5).

C

Incorrect: The scale points should be documented then recording the childs measure of pain (i.e., rates pain 5 out of 10 rather than rates pain a 5). Converting the numeric value to a verbal description is not considered as the best approach.

D

Incorrect: The scale points should be documented then recording the childs measure of pain (i.e., rates pain 5 out of 10 rather than rates pain a 5). Converting the numeric value to a verbal description is not considered as the best approach.

PTS:1REF:p. 588 Pain Assessment

OBJ: Cognitive Level: Comprehension

26.In studies of nurses and childrens perceptions of pain, findings indicate that:

a.

children and nurses agreed on pain levels

b.

children ranked their pain lower than nurses did

c.

nurses could not even come close to the amount of pain the children experienced

d.

children ranked their pain higher than nurses did

ANS: A

Feedback

A

Correct: In studies of nurses and childrens perceptions of pain, findings indicate that children and nurses agreed on pain levels.

B

Incorrect: In studies of nurses and childrens perceptions of pain do not find that children ranked their pain lower than nurses did; in fact, children and nurses agreed on pain levels.

C

Incorrect: In studies of nurses and childrens perceptions of pain do not find that nurses could not even come close to the amount of pain the children experienced; in fact, children and nurses agreed on pain levels.

D

Incorrect: In studies of nurses and childrens perceptions of pain do not find that children ranked their pain higher than nurses did; in fact, children and nurses agreed on pain levels.

PTS:1REF:p. 589 Pain Assessment

OBJ: Cognitive Level: Comprehension

27.The pediatric nurse is aware that the best approach to pain treatment for children is:

a.

early medication for pain

b.

heavy medication up front with smaller follow-up doses

c.

to work to prevent pain

d.

to withhold medication

ANS: C

Feedback

A

Incorrect: Prevention of pain is the best approach to pain treatment for children, not the early medication for pain.

B

Incorrect: Prevention of pain is the best approach to pain treatment for children, not heavy medication up front with smaller follow-up doses.

C

Correct: Prevention is better in treating acute pain because pain that has already occurred and is severe is difficult to control.

D

Incorrect: Prevention of pain is the best approach to pain treatment for children, not withholding medication.

PTS:1REF:p. 591 Management of Acute Pain

OBJ: Cognitive Level: Application

28.When discussing pain management with a child and the parents, the nurse needs to:

a.

assure the child and parents that the child can be kept pain free with good communication

b.

tell them that pain medication and management will improve or relieve the pain, but it has its limitations

c.

teach the child and parents about the possibility of addiction to pain medication

d.

let them know that they need to talk to the physician if the pain medication does not help

ANS: B

Feedback

A

Incorrect: Assuring the child and parents that the child can be kept pain free with good communication is misleading, and inaccurate.

B

Correct: It may not be practical or possible to relieve all the pain unless the child is unconscious. Children and their families need to understand the limitations of effective pain management.

C

Incorrect: Teaching the child and parents about the possibility of addiction to pain medication is not an ideal starting point, since pain management is essential to the best outcome.

D

Incorrect: When discussing pain management with a child and the parents, the nurse does not need to tell them that they need to talk to the physician if the pain medication does not help; first tell the nurse and the nursing staff.

PTS:1REF:p. 582 Pain Management

OBJ: Cognitive Level: Application

29.Which of the following goals is most associated with good pain management?

a.

Maximize function (eating, walking, and participating in the recovery process).

b.

Minimize the amount of pain medication required by smaller dosing.

c.

Make the child feel good at least 90% of the time.

d.

Reduce requests for pain medication to one per shift by time of discharge.

ANS: A

Feedback

A

Correct: Effective pain treatment allows the child the opportunity to walk, eat, and otherwise participate in the recovery process. Adequate pain control may contribute to a shorter hospital stay, promote quicker return to normal functioning, and lead to a more positive hospital experience.

B

Incorrect: Minimizing the amount of pain medication does not meet the first goal of effective pain management, the relief of pain.

C

Incorrect: Making the child feel good at least 90% of the time does not meet the second goal of effective pain management, maximize functioning which suggests aiming for 100%.

D

Incorrect: Reducing requests for pain medication to one per shift by time of discharge is not a goal associated with good pain management as these drugs are dosed or delivered so that side effects are minimized by design.

PTS:1REF:p. 592 Management of Acute Pain

OBJ: Cognitive Level: Comprehension

30.A child continues to complain of pain after being given all the medication that is safe to administer. Which of the following actions should the nurse take?

a.

Provide cutaneous stimulation such as massage, rubbing, holding, and applying heat or cold as indicated.

b.

Distract the child as much as possible, and give the next pain medication a little early.

c.

Ask the mother to tell the child that she cant have any more medication.

d.

Tell the child she will have to wait for more pain medication, and let the child know then she can have more.

ANS: A

Feedback

A

Correct: The nurse also has available nonpharmacologic pain management techniques to use then a child continues to complain of pain after being given all the medication that is safe to administer. One of these techniques involves cutaneous stimulation such as massage, rubbing, holding, and applying heat or cold as indicated.

B

Incorrect: Distracting the child as much as possible is another nonpharmacologic pain management technique, but it is meant to replace more pain medication.

C

Incorrect: Telling the child she will have to wait, and asking the mother to do the telling, does nothing to apply the available nonpharmacologic pain management techniques the nurse can use to reduce the perception of pain.

D

Incorrect: Telling the child she will have to wait, and then she can have more pain medication, does nothing to apply the available nonpharmacologic pain management techniques the nurse can use to reduce the perception of pain.

PTS:1REF:p. 592 Management of Acute Pain

OBJ: Cognitive Level: Application

31.The pediatrician orders an opioid as a pain reliever for a child. The nurse is aware that research has shown that:

a.

children do not tolerate opioid medications well

b.

opioids tend to potentiate other medications to a dangerous level in children

c.

opioids are not a good choice for children over 10 as these children are more prone to addiction than younger children

d.

use of opioids for pain relief in children is unlikely to result in addiction even if used for the long-term

ANS: D

Feedback

A

Incorrect: The nurse is aware that research has shown that children do tolerate opioid medications well then used alone or in combination with other medications.

B

Incorrect: The nurse is aware that research has not shown that opioids tend to potentiate other medications to a dangerous level in children.

C

Incorrect: The nurse is aware that research has shown that opioids are a good choice for children over 10 as the use of opioids for pain relief in children is unlikely to result in addiction even if used for the long-term.

D

Correct: Used alone or in combination with other medications, opioids are among the strongest pain medications and the cornerstone of management for moderate to severe pain, including acute pain and long-term chronic pain. The use of opioids for pain relief is unlikely to result in addiction even then used for the long term.

PTS:1REF:p. 592 Management of Acute Pain

OBJ: Cognitive Level: Comprehension

32.When the nurse administers an opioid to a child, the nurse realizes that the dose to be given is most often obtained by:

a.

a given amount per kilogram or pound of weight

b.

instructions on the container the opioid is packaged in

c.

an educated guess based on past experience of the physician

d.

starting with a low dose and building until relief is obtained

ANS: A

Feedback

A

Correct: When the nurse administers an opioid to a child, the nurse realizes that the dose to be given is most often obtained by a given amount per kilogram or pound of weight. Neonatal doses are reduced by one-third to one-quarter.

B

Incorrect: When the nurse administers an opioid to a child the dose is based upon weight, first, and then it is appropriate to read the instructions on the container.

C

Incorrect: When the nurse administers an opioid to a child the dose is based upon weight, not an educated guess based on past experience of the physician.

D

Incorrect: When the nurse administers an opioid to a child the dose is based upon weight, not the technique for titration (starting with a low dose and building until relief is obtained)

PTS:1REF:p. 592 Management of Acute Pain

OBJ: Cognitive Level: Comprehension

33.The nurse has given a child an opioid for pain relief. Which of the following signs or symptoms would the nurse most likely find on assessment if the child has side effects from the opioid?

a.

dizziness, drowsiness, and lethargy

c.

rapid breathing and rapid pulse

b.

irregular pulse and stomach cramps

d.

nausea, vomiting, and itching

ANS: D

Feedback

A

Incorrect: Side effects from the opioids are not dizziness, drowsiness, and lethargy.

B

Incorrect: Side effects from the opioids are not irregular pulse and stomach cramps.

C

Incorrect: Side effects from the opioids may include depressed respirations, not rapid breathing and rapid pulse.

D

Correct: Side effects from the opioids are most commonly nausea, vomiting, constipation and itching.

PTS:1REF:p. 593 Management of Acute Pain

OBJ: Cognitive Level: Comprehension

34.The physician orders an adult dose of morphine for a 14-year-old who weighs 55 kilograms. The nurse administering opioid pain medication to children is aware then checking the physicians orders that it is safe to give an adult dose to children who weigh more than how many kilograms?

a.

35

c.

45

b.

40

d.

50

ANS: D

Feedback

A

Incorrect: Children under 50 kilograms may not receive adult doses of morphine, and the nurse will question the order.

B

Incorrect: Children under 50 kilograms may not receive adult doses of morphine, and the nurse will question the order.

C

Incorrect: Children under 50 kilograms may not receive adult doses of morphine, and the nurse will question the order.

D

Correct: Larger children (greater than 50 kilograms) may receive adult doses.

PTS:1REF:p. 594 Management of Acute Pain

OBJ: Cognitive Level: Application

35.A pediatric client who has a terminal illness and is in a lot of pain is given an opioid analgesic, which is titrated. The nurse receiving report on this client hears the word titrated and knows this means:

a.

to pass through a special fine-mesh micron filter to remove any impurities

b.

to deliver small, frequent doses of the medication prescribed to the child until the desired effect (pain management) is observed

c.

to give a bolus and follow up the bolus with several small doses if there is breakthrough pain

d.

to mix with a special titration solution, which will better dissolve the opiate because this medication is difficult to dissolve fully

ANS: B

Feedback

A

Incorrect: Filtration is the process of passing a solution through a special fine-mesh micron filter to remove any impurities, it is not the same as titration.

B

Correct: The technique of delivering small doses of the medication until the desired effect (pain relief) is observed is called titration. Titrating the dose up or down may be necessary in order to obtain adequate analgesia with minimal side effects.

C

Incorrect: A bolus is typically a large amount either administered orally or via IV with rapidity, the opposite of titration, i.e., small doses offered frequently.

D

Incorrect: Titration is a process of administering small doses frequently, and has no connection with taking the opiate into solution.

PTS:1REF:p. 592 Management of Acute Pain

OBJ: Cognitive Level: Comprehension

36.Opioids have a unique characteristic in that they have:

a.

no addicting qualities

c.

no ceiling dose

b.

only beneficial side effects

d.

a preconscious effect

ANS: C

Feedback

A

Incorrect: Opioids are not unique because they have no addicting qualities, because it can be addictive.

B

Incorrect: Opioids are not unique because they only have beneficial side effects.

C

Correct: Opioids have a unique characteristic in that they have no ceiling dose (there is no point after which they are no longer effective).

D

Incorrect: Opioids are not unique because they only have a preconscious effect, in fact, they work for the management of pain across the age groups.

PTS:1REF:p. 592 Management of Acute Pain

OBJ: Cognitive Level: Knowledge

37.For children who have the most severe pain, the nurse is aware that opioid analgesics can be given in which of the following ways?

a.

titrated to extremely high doses

b.

up to one and a halftimes the usual dose

c.

bolused with three-fourths of the daily dose

d.

rectally and orally at the same time

ANS: A

Feedback

A

Correct: For children who have the most severe pain, the nurse is aware that opioid analgesics can be titrated to extremely high doses.

B

Incorrect: For children who have the most severe pain, the nurse is aware that opioid analgesics are unique in that they do not have a ceiling dose, and can be titrated in steps until the achievement of adequate analgesia.

C

Incorrect: For children who have the most severe pain, the nurse is aware that opioid analgesics are unique in that they do not have a ceiling dose and can be given small doses frequently instead of bolused with one large dose.

D

Incorrect: For children who have the most severe pain, the nurse is aware that opioid analgesics are not available in a rectal medication.

PTS:1REF:p. 592 Management of Acute Pain

OBJ: Cognitive Level: Comprehension

MULTIPLE RESPONSE

1.Pain management in babies and children has been found in studies to do which of the following? Select all that apply.

a.

to be unnecessary

b.

to promote wound healing

c.

to decrease hospital stays

d.

to cause children to be predisposed to drug addiction

ANS: B, C

Feedback

Correct

Timely and effective pain management has been identified as promoting wound healing.

Timely and effective pain management has been identified as decreasing the length of the hospital stay.

Incorrect

Pain management has been identified as necessary for the pediatric client.

Pain management is not associated with predisposing the child to drug addiction.

PTS:1REF:p. 582 Pain Management

OBJ: Cognitive Level: Application

2.Which type of pain is transmitted by C-nerve fibers? Select all that apply.

a.

diffuse and dull

b.

burning and chronic

c.

pain that comes and goes unexpectedly

d.

unremitting and unbearable pain

ANS: A, B

Feedback

Correct

The C-nerve fibers are one of two types of nociceptors. These fibers are defined as slowly conducting unmyelinated axons that transmit diffuse, dull, burning, and chronic pain.

The C-nerve fibers are one of two types of nociceptors. These fibers are defined as slowly conducting unmyelinated axons that transmit diffuse, dull, burning, and chronic pain.

Incorrect

C-nerve fibers do not transmit pain that comes and goes unexpectedly.

C-nerve fibers do not transmit pain that is unremitting and unbearable.

PTS:1REF:p. 582 Pain Management

OBJ: Cognitive Level: Comprehension

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