Chapter 39: Pain Management for Children My Nursing Test Banks

Chapter 39: Pain Management for Children

Test Bank

MULTIPLE CHOICE

1. When assessing a child for pain, the nurse is aware that

a.

Neonates do not feel pain.

b.

Pain is an individualized experience.

c.

Children do not remember pain.

d.

A child must cry to express pain.

ANS: B

Feedback

A

This is a myth. Neonates do express a total-body response to pain with a cry that is intense, high pitched, and harsh sounding.

B

The manner and intensity of how a child expresses pain is dependent on the individual childs experiences.

C

This is a myth. Children of all ages have been reported to have sleeping and eating disruptions after painful experiences.

D

Not all children will cry to express pain.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 972

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. When pain is assessed in an infant, it is inappropriate to assess for

a.

Facial expressions of pain

b.

Localization of pain

c.

Crying

d.

Thrashing of extremities

ANS: B

Feedback

A

Frowning, grimacing, and facial flinching in an infant may indicate pain.

B

Infants cannot localize pain to any great extent.

C

Infants often exhibit high-pitched, tense, harsh crying to express pain.

D

Infants may exhibit thrashing extremities in response to a painful stimulus.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 972

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. The nurse knows that physiologic changes associated with pain in the neonate include

a.

Increased blood pressure and decreased arterial saturation

b.

Decreased blood pressure and increased arterial saturation

c.

Increased urine output and increased heart rate

d.

Decreased urine output and increased blood pressure

ANS: A

Feedback

A

Increased blood pressure and heart rate and decreased arterial saturation are physiologic responses to pain in the neonate.

B

An increase in blood pressure and a decrease in arterial saturation are documented when the neonate is feeling pain.

C

Although an increase in heart rate is associated with pain, urine output changes have not been associated with pain.

D

An increase in blood pressure occurs with pain, but urine output changes have not been associated with pain.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 973

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

4. What myth may interfere with the treatment of pain in infants and children?

a.

Infants may have sleep difficulties after a painful event.

b.

Children and infants are more susceptible to respiratory depression from narcotics.

c.

Pain in children is multidimensional and subjective.

d.

A childs cognitive level does not influence the pain experience.

ANS: B

Feedback

A

It is true that infants may have sleep difficulties after a painful event. This is not a myth.

B

No data are available to support the belief that infants and children are at higher risk of respiratory depression when given narcotic analgesics. This is a myth.

C

This is a true statement, not a myth.

D

The childs cognitive level, along with emotional factors and past experiences, does influence the perception of pain in children. This is not a myth.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 971 | Table 39-1

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

5. The nurse caring for the child in pain knows that distraction

a.

Can give total pain relief to the child

b.

Is effective when the child is in severe pain

c.

Is the best method for pain relief

d.

Must be developmentally appropriate to refocus attention

ANS: D

Feedback

A

Distraction can help control pain, but it is rarely able to provide total pain relief.

B

Children in severe pain are not distractible.

C

Children may use distraction to help control pain, but it is not the best method for pain relief.

D

Distraction can be very effective in helping to control pain, but it must be appropriate to the childs developmental level.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 978

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

6. What medication is the most effective choice for treating pain associated with sickle cell crisis in a newly admitted 5-year-old child?

a.

Morphine

b.

Acetaminophen

c.

Ibuprofen

d.

Midazolam

ANS: A

Feedback

A

Opioids, such as morphine, are the preferred drugs for the management of acute, severe pain, including postoperative pain, posttraumatic pain, pain from vaso-occlusive crisis, and chronic cancer pain.

B

Acetaminophen provides only mild analgesic relief and is not appropriate for a newly admitted child with sickle cell crisis.

C

Ibuprofen is a type of nonsteroidal antiinflammatory drug (NSAID) that is used primarily for pain associated with inflammation. It is appropriate for mild to moderate pain, but is not adequate for this patient.

D

Midazolam (Versed) is a short-acting drug used for conscious sedation, preoperative sedation, and as an induction agent for general anesthesia.

PTS: 1 DIF: Cognitive Level: Application REF: p. 983

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

7. When using the Poker Chip Tool, it is important for the nurse to know that

a.

Any number of chips can be used.

b.

Only a specified number of chips can be used.

c.

The assessment tool is used with adolescents.

d.

The assessment tool is most effectively used with 2-year-old children.

ANS: B

Feedback

A

Pain tools are valid only if used as directed. The poker chip tool uses four chips.

B

In the poker chip tool, four chips are used to represent a hurt. One chip represents a little hurt, and four chips represent the most hurt the child could have.

C

Adolescents are able to think abstractly. They can describe, quantify, and identify intensity and feelings about pain. This scale is recommended for children ages 4 to 12.

D

Self-report tools are effective in children older than 3 years of age, not 2 years of age.

PTS: 1 DIF: Cognitive Level: Application REF: p. 975 | Table 39-2

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

8. In which developmental stage is the child first able to localize pain and describe both the amount and the intensity of the pain felt?

a.

Toddler stage

b.

Preschool stage

c.

School-age stage

d.

Adolescent stage

ANS: B

Feedback

A

The toddler expresses pain by guarding or touching the painful area, verbalizes words that indicate discomfort such as ouch and hurt, and demonstrates generalized restlessness when feeling pain.

B

The preschool stage is the period when the child is first able to describe the location and intensity of pain, stating, for example, Ear hurts bad, when feeling pain.

C

The preschool stage is the period when the child is first able to describe the location and intensity of pain. The school-age child describes both the location of the pain and its intensity.

D

The preschool stage is the period when the child is first able to describe the location and intensity of pain. The adolescent also describes location and intensity of pain.

PTS: 1 DIF: Cognitive Level: Application REF: p. 972 | Box 39-2

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. Which statement indicates the nurses lack of understanding about the use of patient-controlled analgesia (PCA) therapy?

a.

Children as young as 3 years old can effectively and successfully use a PCA pump.

b.

Two registered nurses (RNs) are required to double-check the dosage and programmed administration of opioids.

c.

The child should be carefully monitored for signs and symptoms of overmedication with opioids.

d.

Naloxone (Narcan) should be readily available.

ANS: A

Feedback

A

Children as young as 5 years old have effectively used PCA therapy. Further data are needed to evaluate the use of PCA therapy in children younger than 5 years of age.

B

Two RNs are needed to check the amount of opioid being administered. Once the opioid infusion is hung and programmed, a second RN must double-check the process.

C

Children receiving PCA therapy should be monitored closely to ensure effective pain control and for signs or symptoms of overmedication. Initially, vital signs should be monitored every 15 to 30 minutes and then every 2 to 4 hours. Respiratory rate should be assessed every hour.

D

Narcan should be readily available to reverse opioid overmedication exhibited by respiratory distress.

PTS: 1 DIF: Cognitive Level: Application REF: p. 980

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

10. Which assessment indicates to a nurse that a 2-year-old child is in need of pain medication?

a.

The child is lying rigidly in bed and not moving.

b.

The childs current vital signs are consistent with vital signs over the past 4 hours.

c.

The child becomes quiet when held and cuddled.

d.

The child has just returned from the recovery room.

ANS: A

Feedback

A

Behaviors such as crying; distressed facial expressions; certain motor responses, such as lying rigidly in bed and not moving; and interrupted sleep patterns are indicative of pain in children.

B

Current vital signs that are consistent with earlier vital signs do not suggest that the child is feeling pain.

C

Response to comforting behaviors does not suggest the child is feeling pain.

D

A child who is returning from the recovery room may or may not be in pain. Most times the childs pain is under adequate control at this time. The child may be fearful or having anxiety because of the strange surroundings and having just completed surgery.

PTS: 1 DIF: Cognitive Level: Application REF: p. 974

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

11. When assessing pain in any child, the nurse should consider that

a.

Any pain assessment tool can be used to assess pain in children.

b.

Children as young as 1 year old use words to express pain.

c.

The childs behavioral, physiologic, and verbal responses are valuable when assessing pain.

d.

Pain assessment tools are minimally effective for communicating about pain.

ANS: C

Feedback

A

The childs age is important in determining the appropriate pain assessment tool to use.

B

Developmentally appropriate assessment tools need to be used to effectively identify and determine the level of pain felt by a child. Toddlers may use words such as ouch or hurt to identify pain, but infants and young children may not have the language or cognitive abilities to express pain.

C

Childrens behavioral, physiologic, and verbal responses are indicative when assessing pain. The use of pain measurement tools greatly assists in communicating about pain.

D

Pain assessment tools when used appropriately are successful and efficient in identifying and quantifying pain with children. Behavioral and physiologic signs and symptoms in combination with pain assessment tools are most effective in diagnosing pain levels in children.

PTS: 1 DIF: Cognitive Level: Application REF: p. 975

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

12. The nurse is caring for a 6-year-old girl who had surgery 12 hours ago. The child tells the nurse that she does not have pain, but a few minutes later tells her parent that she does. What should the nurse consider when interpreting this?

a.

Truthful reporting of pain should occur by this age.

b.

Inconsistency in pain reporting suggests that pain is not present.

c.

Children use pain experiences to manipulate their parents.

d.

Children may be experiencing pain even though they deny it to the nurse.

ANS: D

Feedback

A

These are common fallacies about children and pain.

B

These are common fallacies about children and pain.

C

Pain is whatever the experiencing person says it is, whenever the person says it exists. Pain is not questioned in an adult 12 hours after surgery.

D

Children may deny pain to the nurse because they fear receiving an injectable analgesic or because they believe they deserve to suffer as a punishment for a misdeed. They may refuse to admit pain to a stranger, but readily tell a parent.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 972 | Box 39-2

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

13. Which drug is usually the best choice for PCA for a child in the immediate postoperative period?

a.

Codeine

b.

Morphine

c.

Methadone

d.

Meperidine

ANS: B

Feedback

A

Parenteral use of codeine is not recommended.

B

The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl.

C

This is not available in parenteral form in the United States.

D

Meperidine is not used for continuous and extended pain relief.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 984

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

14. 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. The most appropriate management of this child is for the nurse to

a.

Administer naloxone (Narcan).

b.

Discontinue IV infusion.

c.

Discontinue morphine until child is fully awake.

d.

Stimulate child by calling name, shaking gently, and asking to breathe deeply.

ANS: A

Feedback

A

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.

B

The morphine should be discontinued, but naloxone is indicated if the child is unresponsive.

C

The morphine should be discontinued, but naloxone is indicated if the child is unresponsive.

D

The child is unresponsive. Naloxone is indicated.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 984

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

MULTIPLE RESPONSE

1. Which medications are the most effective choices for treating pain associated with inflammation in children? Select all that apply.

a.

Morphine

b.

Acetaminophen (Tylenol)

c.

Ibuprofen (Advil)

d.

Ketorolac (Toradol)

e.

Aspirin

ANS: C, D

Feedback

Correct

Ibuprofen, naproxen/naproxen sodium, and ketorolac are all types of NSAIDs, which are used primarily for pain associated with inflammation.

Incorrect

Opioids, such as morphine, are the preferred drugs for the management of acute, severe pain, including postoperative pain, posttraumatic pain, pain from vaso-occlusive crisis, and chronic cancer pain. Acetaminophen lacks the antiinflammatory effects of NSAIDs and provides only minimal antiinflammatory relief. Although aspirin is an antiinflammatory medication, because of its association with Reyes syndrome, its use is not recommended in children.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 982

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. The appropriate tool(s) to assess pain in a 3-year-old child is the (select all that apply)

a.

Visual Analogue Scale (VAS)

b.

Adolescent and pediatric pain tool

c.

Oucher tool

d.

Poker Chip Tool

e.

FACES pain rating scale

ANS: C, D, E

Feedback

Correct

The Oucher Tool can be used to assess pain in children 3 to 12 years of age.The poker chip tool can be used to assess pain in children 4 to 12 years of age. The FACES pain rating scale can be used to assess pain for children 3 years of age and older.

Incorrect

The VAS is indicated for use with older school-age children and adolescents. It can be used with younger school-age children, although less abstract tools are more appropriate. The adolescent and pediatric pain tool is indicated for use with children 8 to 17 years of age.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 975 | Table 39-2

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. A nurse is administering an opioid medication to a child. Which side effects should the nurse watch for with this classification of medication? Select all that apply.

a.

Respiratory depression

b.

Hepatic damage

c.

Constipation

d.

Pruritus

e.

Gastrointestinal bleeding

ANS: A, C, D

Feedback

Correct

The nurse should remember opioids can produce sedation and respiratory depression in addition to analgesia. Other adverse effects can include constipation, pruritus, nausea, vomiting, cough suppression, and urinary retention.

Incorrect

Acetaminophen is associated with hepatic damage, and NSAIDs are associated with gastrointestinal bleeding.

PTS: 1 DIF: Cognitive Level: Application REF: p. 984

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

COMPLETION

1. Skin to skin holding of infants dressed only in a diaper, next to their mothers or fathers chest is commonly known as __________ care.

ANS:

kangaroo

Infants who spent 1 to 3 hours in kangaroo care showed increased frequency in quiet sleep, longer duration of quiet sleep and decreased crying in the NICU. Significant differences were found in pain responses during heel lancing between infants who were kangaroo held and those that were not.

PTS: 1 DIF: Cognitive Level: Application REF: p. 978

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. The nurse is discussing various non-pharmacologic pain-relief techniques with the father of an 8-year-old boy. They agree on a plan to use a modality where the child is encouraged to remember or imagine the sights and sounds of an enjoyable experience such as his birthday. This is known as ________________ .

ANS:

guided imagery

The facilitator (nurse or child-life specialist) talks in a calm voice while guiding the childs imagination. Studies have shown a reduction in pain from all causes using this technique.

PTS: 1 DIF: Cognitive Level: Application REF: p. 979 | Table 39-3

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

TRUE/FALSE

1. The nurse is preparing a 4-year-old with a fractured humerus for an MRI. While the nurse is explaining the procedure to the childs parents, she understands that procedural sedation is a medically controlled state of depressed consciousness that will allow the child to be able to respond appropriately and to maintain her airway control. Is this statement true or false?

ANS: T

There is a continuum of sedation levels; minimum, moderate (conscious sedation), and deep. The child will remain alert and only experience mild anxiety or may become deeply sedated.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 985

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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