Chapter 40

Question 1

While making rounds, the nurse observes all of the following client behaviors. Which child should the nurse further evaluate for postoperative pain?

1. The 6-month-old in deep sleep.
2. The 2-year-old who is cooperative when the nurse takes vital signs.
3. The 4-year-old who is actively watching cartoons.
4. The 14-month-old who is thrashing his arms and legs.

Answer 1

4

Question 2

The nurse is taking care of a postoperative school-age child. The child’s mother requests that the child not receive narcotics because she is afraid the child will become addicted. The nurse should explain that children who do not receive adequate pain control will be at risk for which complication?

1. Respiratory
2. Urinary
3. Cardiac
4. Bowel

Answer 2

1

Question 3

The nurse is caring for a postoperative toddler-age child. Which pain assessment tool should the nurse use to assess this child’s pain?

1. Poker Chip Tool
2. Oucher Scale
3. Faces Pain Rating Scale
4. FLACC Behavioral Pain Assessment Scale

Answer 3

4

Question 4

A 5-year-old child is hospitalized with a fractured femur. Which tool should the nurse use to assess this child’s pain?

1. CRIES Scale
2. Faces Pain Rating Scale
3. SUN Scale
4. PIPP Scale

Answer 4

2

Question 5

During the nurse’s initial assessment of a school-age child, the child reports a pain level of 6 out of 10. The child is lying quietly in bed watching television. Which nursing action is appropriate?

1. Reassess the child in 15 minutes to see if the pain rating has changed.
2. Administer the prescribed analgesic.
3. Do nothing, since the child appears to be resting.
4. Ask the child’s parents if they think the child is hurting.

Answer 5

2

Question 6

A hospitalized 3-year-old child needs to have an IV restarted. The child begins to cry when carried into the treatment room by the mother. Which is an appropriate nursing diagnosis to address this situation?

1. Knowledge Deficit of the procedure
2. Fear related to the unfamiliar environment
3. Anxiety related to anticipated painful procedure
4. Ineffective Individual Coping related to an invasive procedure

Answer 6

3

Question 7

A nurse is providing care for a pediatric client in the intensive care unit (ICU) who has been on opioids for an extended period of time. Which assessment finding indicates to the nurse that the child is experiencing withdrawal symptoms related to the opioid weaning process?

1. Hyperactive deep tendon reflexes, vomiting, and abdominal cramps.
2. Bradycardia and pallor.
3. Decreased blood pressure and drowsiness.
4. Voracious appetite and hypotonicity.

Answer 7

1

Question 8

An analgesic is prescribed for a postsurgical pediatric client to be administered every 3 to 4 hours. Which can occur if the nurse is delayed in administering the prescribed analgesic?

1. Decrease in the chance of withdrawal symptoms
2. Decrease in the chance of addiction
3. Increase in the chance of breakthrough pain
4. Increase in the child’s pain tolerance

Answer 8

3

Question 9

The nurse is preparing to perform a heel stick on a neonate. Which complementary therapy should the nurse implement to decrease pain during this quick but painful procedure?

1. Holding the newborn
2. Providing a sucrose pacifier to the newborn
3. Massaging the newborn
4. Swaddling the newborn

Answer 9

2

Question 10

A 6-year-old postoperative client’s IV infiltrates and has to be restarted immediately for medication. There is no time for placing local anesthetic cream on the skin. Which complementary therapy would be helpful when placing this IV?

1. Restraints
2. Moderate sedation
3. Anesthesia
4. Distraction

Answer 10

4

Question 11

The pediatric nurse would expect that patient-controlled analgesia (PCA) would be most appropriate for which client?

1. 12-year-old client who is postoperative for spinal fusion for scoliosis
2. 10-year-old client who has a fractured femur and concussion from a bike accident
3. 5-year-old client who is postoperative for tonsillectomy
4. Developmentally delayed 16-year-old client who is postoperative for bone surgery.

Answer 11

1

Question 12

Which statement by the parent of a preschool-age child would indicate the need for further teaching regarding pain management?

1. “I will call the office tomorrow if the pain medicine is not relieving the pain.”
2. “I can expect my child to have some pain for the next few days.”
3. “Because my child just had surgery today, I can expect the pain level to be higher tomorrow.”
4. “I will plan to give my child pain medicine around the clock for the next day or so.”

Answer 12

3

Question 13

The nurse is caring for a child who has been sedated for a painful procedure. Which is the priority nursing action?

1. Placing the child on a cardiac monitor
2. Allowing parents to stay with the child
3. Monitoring pulse oximetry
4. Assessing the child’s respiratory effort

Answer 13

4

Question 14

The nurse is planning care for a preschool-age child who is intellectually disabled and is scheduled for surgery the next day. Which should the nurse consider when choosing a pain assessment tool? Select all that apply.

1. The child’s language skills
2. The child’s ability to understand the concept of more and less
3. The child’s ability to sit for a 10-minute evaluation
4. The child’s ability to perceive pain
5. The child’s ability to understand pain

Answer 14

1,2

Question 15

The nurse administers IV morphine to a 4-year-old postoperative client. Which assessment finding requires further evaluation by the nurse?

1. Pulse decreased from 136 to 104
2. Blood pressure dropped from 110/72 to 90/55
3. Respiratory rate went from 42 to 16
4. Child pulls away from nurse who wants to assess surgical site

Answer 15

3

Question 16

The healthcare provider prescribes hydromorphine (Dilaudid) intravenously for the postoperative 4-year-old child. The therapeutic range for Dilaudid has been determined to be 0.01 to 0.015 mg/kg/dose every 3 to 4 hours. What is the maximum therapeutic dose of Dilaudid if the child weighs 30 pounds? Round your answer to the nearest hundredth.

Answer 16

0.2 mg

Question 17

During shift report, the night nurse reports that a terminally ill child has developed tolerance to the prescribed morphine. Which concept should the nurse use when planning care for this child?

1. The child is physically dependent on morphine.
2. The child is addicted to morphine.
3. The child is showing physical signs of withdrawal.
4. The child will need more medication to achieve the same effect.

Answer 17

4

Question 18

The 17-month-old toddler, diagnosed with terminal cancer, is experiencing constant pain. Which prescription does the nurse anticipate from the healthcare provider for this toddler?

1. Patient-controlled analgesia (PCA) with the parents controlling the button that administers the dosage
2. Intravenously administered opioids on a scheduled basis
3. Intravenously administered opioids on a prn basis
4. Orally administered opioids on a prn basis

Answer 18

2

Question 19

Which distraction techniques should the nurse to use for a school-age child during a painful procedure? Select all that apply.

1. Blowing bubbles
2. Music therapy
3. Guided imagery
4. Hypnosis
5. Sucrose solution

Answer 19

1,2,3

Question 20

Which nonpharmacologic interventions are appropriate for the nurse to use when treating pediatric clients in pain? Select all that apply.

1. Regional nerve block
2. Cutaneous stimulation
3. Application of heat
4. Electroanalgesia
5. Use of EMLA cream

Answer 20

2,3,4

Question 21

The nurse is providing care to a pediatric client who is receiving sedation for a painful procedure. Which are the priority nursing actions? Select all that apply.

1. Monitoring respirations
2. Assessing for manifestations of deep sedation
3. Ensuring a crash cart is available
4. Administering the prescribed opioid
5. Administering the prescribed benzodiazepine

Answer 21

1,2,3

Question 22

Which are the priority nursing assessments when providing care to a pediatric client who is receiving sedation? Select all that apply.

1. Respiratory effort
2. Chest wall movement
3. Skin color
4. Level of consciousness
5. Pain

Answer 22

1,2,3,4

Question 23

Which are discharge criteria the nurse includes in the plan of care for a client who has received sedation? Select all that apply.

1. Stable vital signs
2. Patent airway
3. Ability to sit up without assistance
4. Adequate fluid intake
5. Ability to urinate

Answer 23

1,2,3

Question 24

Which pediatric diagnoses require the nurse to include interventions to treat chronic pediatric client pain in the plan of care? Select all that apply.

1. Juvenile idiopathic arthritis
2. Sickle cell disease
3. Attention deficit hyperactivity disorder (ADHD)
4. Cancer
5. Human immunodeficiency virus (HIV)

Answer 24

1,2,4

Question 25

Which complementary pain management interventions should the nurse include in the plan of care for a pediatric client who is experiencing chronic pain? Select all that apply.

1. Hypnosis
2. Guided imagery
3. Patient-controlled analgesia (PCA)
4. Fentanyl patch
5. EMLA cream

Answer 25

1,2