San Jacinto College - RNSG 2201

Chapter 05: Pain Assessment and Management in Children Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

MULTIPLE CHOICE

1)A 2-year-old child has been returned to the nursing unit after an inguinal hernia repair. Which pain assessment tool should the nurse use to assess this child for the presence of pain?

1. 1. FACES pain rating tool
   2. Numeric scale
   3. Oucher scale
   4. FLACC tool

2. 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,NbUuRt SaIfNeGwTBm.CinOuMtes later she tells her parents that she does. Which should the nurse consider when interpreting this?
   1. Truthful reporting of pain should occur by this age.
   2. Inconsistency in pain reporting suggests that pain is not present.
   3. Children use pain experiences to manipulate their parents.
   4. Children may be experiencing pain even though they deny it to the nurse.

3. A nurse is gathering a history on a school-age child admitted for a migraine headache. The child states, “I have been getting a migraine every 2 or 3 months for the last year.” The nurse documents this as which type of pain?
   1. Acute
   2. Chronic

1. 3. Recurrent
   4. Subacute

4. Physiologic measurements in children’s pain assessment are:
   1. the best indicator of pain in children of all ages.
   2. essential to determine whether a child is telling the truth about pain.
   3. of most value when children also report having pain.
   4. of limited value as sole indicator of pain.

5. Nonpharmacologic strategies for pain management:
   1. may reduce pain perception.
   2. make pharmacologic strategies unnecessary.
   3. usually take too long to implement.
   4. trick children into believing they do not have pain.

6. Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period?
   1. Codeine
   2. Morphine
   3. Methadone
   4. Meperidine

7. A lumbar puncture is needed on a school-age child. What should the nurse apply to provide the most appropriate analgesia during this procedure?
   1. TAC (tetracaine-adrenaline-cocaine) 15 minutes
   2. Transdermal fentanyl (Duragesic) patch immediately
   3. EMLA (eutectic mixture of local anesthetics) 1 hour
   4. EMLA (eutectic mixture of local anesthetics) 30 minutes

8. 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 priority nursing action?
   1. Administer naloxone (Narcan)
   2. Discontinue IV infusion
   3. Discontinue morphine until child is fully awake
   4. Stimulate child by calling name, shaking gently, and asking to breathe deeply

9. The nurse is completing a pain assessment on a 4-year-old child. Which of the depicted pain scale tools should the nurse use with a child this age?

a.

b.

c.

d.

10. Fentanyl and midazolam (Versed) are given before débridement of a child’s burn wounds. Which is the rationale for administration of these medications?
    1. Promote healing
    2. Prevent infection
    3. Provide pain relief
    4. Limit amount of débridement that will be necessary

11. Nitrous oxide is being administered to a child with extensive burn injuries. Which is the purpose of this medication?
    1. Promote healing
    2. Prevent infection
    3. Provide anesthesia
    4. Improve urinary output

MULTIPLE RESPONSE

1. A nurse recognizes which physiologic responses as a manifestation of pain in a neonate?
   1. Decreased respirations
   2. Diaphoresis
   3. Decreased SaO2

1. 4. Decreased blood pressure
   5. Increased heart rate

2. A nurse is monitoring a patient for side effects associated with opioid analgesics. Which side effects should the nurse expect to monitor for?
   1. Diarrhea
   2. Respiratory depression
   3. Hypertension
   4. Pruritus
   5. Sweating

3. Which dietary recommendations should a nurse make to an adolescent patient to manage constipation related to opioid analgesic administration?
   1. Bran cereal
   2. Decrease fluid intake
   3. Prune juice
   4. Cheese
   5. Vegetables

4. Surgery has informed a nurse that the patient returning to the floor after spinal surgery has an opioid epidural catheter for pain management. The nurse should prepare to monitor the patient for which side effects of an opioid epidural catheter?

1. 1. Urinary frequency
   2. Nausea
   3. Itching
   4. Respiratory depression

SHORT ANSWER

1. A dose of oxycodone (OxyContin) 2 mg/kg has been ordered for a child weighing 33 lb. How many milligrams of OxyContin should the nurse administer? (Record your answer as a whole number.)

2. A nurse is using the FLACC scale to evaluate pain in a preverbal child. The nurse makes the following assessment: Face: occasional grimace; Leg: relaxed; Activity: squirming, tense; Cry: no cry; Consolability: content, relaxed. The nurse records the FLACC assessment as which number? (Record your answer as a whole number.)

OTHER

1. A patient on an intravenous opioid analgesic has become apneic. The nurse should implement which interventions? Place the interventions in order from the highest priority (first intervention) to the lowest priority (last intervention). Provide your answer using lowercase letters separated by commas (e.g., a, b, c, d).

1. 1. Place the patient on continuous pulse oximetry to assess SaO2.
   2. Administer the prescribed naloxone (Narcan) dose by slow IV push.
   3. Ensure oxygen is available.