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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
Correct Answer: A
Rationale: No hurt is a phrase that is simple, concrete, and appropriate to the preoperational stage of the child. Using color is complicated for this age group. The child needs to identify colors and pain levels and then choose an appropriate symbolic color. This is appropriate for an older child. Zero is an abstract construct not appropriate for this age group. Least pain is less concrete than no hurt.
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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)
Correct Answer: B
Rationale: The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone in parenteral form is not used in a PCA but is given orally or intravenously for pain in the infant. Meperidine is not used for continuous and extended pain relief.
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.
Correct Answer: A
Rationale: Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. The nonpharmacologic strategy should be matched with the childs pain severity and be taught to the child before the onset of the painful experience. Tricking children into believing they do not have pain may mitigate the childs experience with mild pain, but the child will still know the discomfort was present.
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.
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.