Nokea
The nurse is teaching the parents of a child with recurrent headaches methods to modify behavior patterns that increase the risk of headache. Which statement by the parents indicates understanding the teaching?
- A. We will allow the child to miss school if a headache occurs.
- B. We will respond matter-of-factly to requests for special attention.
- C. We will be sure to give much attention to our child when a headache occurs.
- D. We will be sure our child doesnt have to perform at a band concert if a headache occurs.
Correct Answer: B
Rationale: To modify behavior patterns that increase the risk of headache or reinforce headache activity, the nurse instructs the parents to avoid giving excessive attention to their childs headache and to respond matter-of-factly to pain behavior and requests for special attention. Parents learn to assess whether the child is avoiding school or social performance demands because of headache.
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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.
The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurses response should be based on which characteristic about preterm infants pain?
- A. They may react to painful stimuli but are unable to remember the pain experience.
- B. They perceive and react to pain in much the same manner as children and adults.
- C. They do not have the cortical and subcortical centers that are needed for pain perception.
- D. They lack neurochemical systems associated with pain transmission and modulation.
Correct Answer: B
Rationale: Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.
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.
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.
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.