Nokea
The nurse is teaching a staff development program about levels of sedation in the pediatric population. Which statement by one of the participants should indicate a correct understanding of the teaching?
- A. With minimal sedation, the patients respiratory efforts are affected, and cognitive function is not impaired.
- B. With general anesthesia, the patients airway cannot be maintained, but cardiovascular function is maintained.
- C. During deep sedation, the patient can be easily aroused by loud verbal commands and tactile stimulation.
- D. During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation.
Correct Answer: D
Rationale: When discussing levels of sedation, the participants should understand that during moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation, cognitive function is impaired, and respiratory function is adequate. In minimal sedation, the patient responds to verbal commands and may have impaired cognitive function; the respiratory and cardiovascular systems are unaffected. In deep sedation, the patient cannot be easily aroused except by painful stimuli; the airway and spontaneous ventilation may be impaired, but cardiovascular function is maintained. With general anesthesia, the patient loses consciousness and cannot be aroused with painful stimuli, the airway cannot be maintained, and ventilation is impaired; cardiovascular function may or may not be impaired.
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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.
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 nonpharmacologic intervention appears to be effective in decreasing neonatal procedural pain?
- A. Tactile stimulation
- B. Commercial warm packs
- C. Doing procedure during infant sleep
- D. Oral sucrose and nonnutritive sucking
Correct Answer: D
Rationale: Nonnutritive sucking attenuates behavioral, physiologic, and hormonal responses to pain. The addition of sucrose has been demonstrated to have calming and pain-relieving effects for neonates. Tactile stimulation has a variable effect on response to procedural pain. No evidence supports commercial warm packs as a pain control measure. With resulting increased blood flow to the area, pain may be greater. The infant should not be disturbed during the sleep cycle. It makes it more difficult for the infant to begin organization of sleep and awake cycles.
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.
The nurse is planning to administer a nonopioid for pain relief to a child. Which timing should the nurse plan to ensure maximum effect?
- A. 15 minutes until maximum effect
- B. 30 minutes until maximum effect
- C. 1 hour until maximum effect
- D. 1 1/2 hours until maximum effect
Correct Answer: C
Rationale: Nonsteroidal antiinflammatory drugs (NSAIDs) can provide safe and effective pain relief when dosed at appropriate levels with adequate frequency. Most NSAIDs take about 1 hour for effect, so timing is crucial.