Nokea
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.
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A bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which?
- A. Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure.
- B. Use a combination of fentanyl and midazolam for conscious sedation.
- C. Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure.
- D. Apply a transdermal fentanyl (Duragesic) patch immediately before the procedure.
Correct Answer: B
Rationale: A bone marrow biopsy is a painful procedure. The combination of fentanyl and midazolam should be used to provide conscious sedation. TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin. The gel can be placed on a wound for suturing. It is not sufficient for a bone marrow biopsy. EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. For this procedure, systemic analgesia is required. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control.
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.
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.
A cancer patient is experiencing neuropathic cancer pain. Which prescription should the nurse expect to be ordered to control anxiety?
- A. Lorazepam (Ativan)
- B. Gabapentin (Neurontin)
- C. Hydromorphone (Dilaudid)
- D. Morphine sulfate (MS Contin)
Correct Answer: B
Rationale: Anticonvulsants (gabapentin, carbamazepine) have demonstrated effectiveness in neuropathic cancer pain. Ativan is an antianxiety agent, and Dilaudid and MS Contin are opioid analgesics.
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.