Nokea
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.
Correct Answer: C
Rationale: 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.
You may also like to solve these questions
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.
Correct Answer: A
Rationale: 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.
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.
Correct Answer: B
Rationale: 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 childs estimate of the pain should be used. The physiologic measures may not reflect more long-term pain.
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)
Correct Answer: A
Rationale: A benzodiazepine such as lorazepam is prescribed as an antianxiety agent. Oxycodone, fentanyl, and morphine sulfate are opioid analgesics.
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
Correct Answer: B
Rationale: 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.
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
Correct Answer: A
Rationale: 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.