Nursing Care of Children Principles and Practice 3rd edition by Susan R. James Test Bank

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Nursing Care of Children Principles and Practice 3rd edition by Susan R. James Test Bank

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James: Nursing Care of Children: Principles and Practice, 3rd Edition
Test Bank
Chapter 15: Pain Management for Children
MULTIPLE CHOICE

1. The nurse is aware when assessing a child for pain that:
a. neonates do not feel pain.
b. pain is an individualized experience.
c. children do not remember pain.
d. a child must cry to express pain.

ANS: B

Feedback
A This is a myth. Neonates do express a total-body response to pain with a cry that is intense, high pitched, and harsh sounding.
B The manner and intensity of how a child expresses pain is dependent on the individual childs experiences.
C This is a myth. Children of all ages have been reported to have sleeping and eating disruptions after painful experiences.
D Not all children will cry to express pain.

DIF: Cognitive Level: Comprehension REF: Text Reference: pg 396
OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. When pain is assessed in an infant, it would be inappropriate to assess for which of the following?
a. Facial expressions of pain
b. Localization of pain
c. Crying
d. Thrashing of extremities

ANS: B

Feedback
A Frowning, grimacing, and facial flinching in an infant may indicate pain.
B Infants cannot localize pain to any great extent.
C Infants often exhibit high-pitched, tense, harsh crying to express pain.
D Infants may exhibit thrashing extremities in response to a painful stimulus.

DIF: Cognitive Level: Comprehension REF: Text Reference: pg 399
OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. The nurse is aware that physiologic changes associated with pain in the neonate include which of the following?
a. Increased blood pressure and decreased arterial saturation
b. Decreased blood pressure and increased arterial saturation
c. Increased urine output and increased heart rate
d. Decreased urine output and increased blood pressure

ANS: A

Feedback
A Increased blood pressure and heart rate and decreased arterial saturation are physiologic responses to pain in the neonate.
B An increase in blood pressure and a decrease in arterial saturation are documented when the neonate is feeling pain.
C Although an increase in heart rate is associated with pain, urine output changes have not been associated with pain.
D An increase in blood pressure occurs with pain, but urine output changes have not been associated with pain.

DIF: Cognitive Level: Comprehension REF: Text Reference: pg 399
OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. Which of the following is a myth that may interfere with the treatment of pain in infants and children?
a. Infants may have sleep difficulties after a painful event.
b. Children and infants are more susceptible to respiratory depression from narcotics.
c. Pain in children is multidimensional and subjective.
d. A childs cognitive level does not influence the pain experience.

ANS: B

Feedback
A It is true that infants may have sleep difficulties after a painful event. This is not a myth.
B No data are available to support the belief that infants and children are at higher risk of respiratory depression when given narcotic analgesics. This is a myth.
C This is a true statement, not a myth.
D The childs cognitive level, along with emotional factors and past experiences, does influence the perception of pain in children. This is not a myth.

DIF: Cognitive Level: Comprehension REF: Text Reference: pg 398
OBJ: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

5. The nurse caring for the child in pain knows that distraction:
a. can give total pain relief to the child.
b. is effective when the child is in severe pain.
c. is the best method for pain relief.
d. must be developmentally appropriate to refocus attention.

ANS: D

Feedback
A Distraction can help control pain but is rarely able to provide total pain relief.
B Children in severe pain are not distractible.
C Children may use distraction to help control pain, but it is not the best method for pain relief.
D Distraction can be very effective in helping to control pain, but it must be appropriate to the childs developmental level.

DIF: Cognitive Level: Comprehension REF: Text Reference: pg 406
OBJ: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

6. Which of the following medications is the most effective choice for treating pain associated with inflammation?
a. Opioids
b. Acetaminophen
c. Ibuprofen
d. Midazolam

ANS: C

Feedback
A Opioids are the preferred drugs for the management of acute, severe pain, including postoperative pain, posttraumatic pain, pain from vaso-occlusive crisis, and chronic cancer pain.
B Acetaminophen lacks the anti-inflammatory effects of nonsteroidal antiinflammatory drugs (NSAIDs) and provides only minimal anti-inflammatory relief.
C Ibuprofen is a type of NSAID, which is used primarily for pain associated with inflammation.
D Midazolam (Versed) is a short-acting drug used for conscious sedation, preoperative sedation, and as an induction agent for general anesthesia.

DIF: Cognitive Level: Comprehension REF: Text Reference: pg 409
OBJ: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

7. When using the Poker Chip Tool, it is important for the nurse to know which of the following?
a. Any number of chips can be used.
b. Only a specified number of chips can be used.
c. The assessment tool is used with adolescents.
d. The assessment tool is most effectively used with 2-year-old children.

ANS: B

Feedback
A Pain tools are valid only if used as directed. The Poker Chip Tool uses four chips.
B In the Poker Chip Tool, four chips are used to represent a hurt. One chip represents a little hurt, and four chips represent the most hurt the child could have.
C Adolescents are able to think abstractly. They can describe, quantify, and identify intensity and feelings about pain. This scale is recommended for children ages 4 to 12.
D Self-report tools are effective in children older than 3 years of age, not 2 years of age.

DIF: Cognitive Level: Knowledge REF: Text Reference: pgs 402-403
OBJ: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

8. An appropriate tool to assess pain in a 3-year-old child would be which of the following?
a. The Visual Analogue Scale (VAS)
b. The Adolescent and Pediatric Pain Tool
c. The Oucher Tool
d. The Poker Chip Tool

ANS: C

Feedback
A The VAS is indicated for use with older school-age children and adolescents. It can be used with younger school-age children, although less-abstract tools are more appropriate.
B The Adolescent and Pediatric Pain Tool is indicated for use with children 8 to 17 years of age.
C The Oucher Tool can be used to assess pain for children 3 to 12 years of age.
D The Poker Chip Tool can be used to assess pain in children 4 to 12 years of age.

DIF: Cognitive Level: Knowledge REF: Text Reference: pg 403
OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

9. In which of the following developmental stages is the child first able to localize pain and describe both the amount and the intensity of the pain felt?
a. Toddler stage
b. Preschool stage
c. School-age stage
d. Adolescent stage

ANS: B

Feedback
A The toddler expresses pain by guarding or touching the painful area, verbalizes words that indicate discomfort, such as ouch and hurt, and demonstrates generalized restlessness when feeling pain.
B The preschool stage is the period when the child is first able to describe the location and intensity of pain, stating for example, ear hurts bad, when feeling pain.
C The preschool stage is the period when the child is first able to describe the location and intensity of pain. The school-age child describes both the location of the pain and its intensity.
D The preschool stage is the period when the child is first able to describe the location and intensity of pain. The adolescent also describes location and intensity of pain.

DIF: Cognitive Level: Knowledge REF: Text Reference: pg 399
OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

10. Which of the following statement indicates a nurses lack of understanding about the use of patient-controlled analgesia (PCA) therapy?
a. Children as young as 3 years old can effectively and successfully use a PCA pump.
b. Two registered nurses (RNs) are required to double check the dosage and programmed administration of opioids.
c. The child should be carefully monitored for signs and symptoms of overmedication with opioids.
d. Naloxone (Narcan) should be readily available.

ANS: A

Feedback
A Children as young as 5 years old have effectively used PCA therapy. Further data are needed to evaluate the use of PCA therapy in children younger than 5 years of age.
B Two RNs are needed to check the amount of opioid being administered. Once the opioid infusion is hung and programmed, a second RN must double check the process.
C Children receiving PCA therapy should be monitored closely to ensure effective pain control and for signs or symptoms of overmedication. Initially, vital signs should be monitored every 15 to 30 minutes and then every 2 to 4 hours. Respiratory rate should be assessed every hour.
D Narcan should be readily available to reverse opioid overmedication exhibited by respiratory distress.

DIF: Cognitive Level: Knowledge REF: Text Reference: pg 407
OBJ: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

11. Which of the following assessments indicates to a nurse that a 2-year-old child is in need of pain medication?
a. The child is lying rigidly in bed and not moving.
b. The childs current vital signs are consistent with vital signs over the past 4 hours.
c. The child is quieted when held and cuddled.
d. The child has just returned from the recovery room and is crying.

ANS: A

Feedback
A Behaviors such as crying, distressed facial expressions, certain motor responses such as lying rigidly in bed and not moving, and interrupted sleep patterns are indicative of pain in children.
B Current vital signs that are consistent with earlier vital signs do not suggest that the child is feeling pain.
C Response to comforting behaviors does not suggest the child is feeling pain.
D Crying in a child who is returning from the recovery room may not be indicative of pain. The child may just be fearful or having anxiety because of the strange surroundings and having just completed surgery.

DIF: Cognitive Level: Application REF: Text Reference: pg 399
OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

12. When assessing pain in any child, the nurse should consider which of the following?
a. Any pain assessment tool can be used to assess pain in children.
b. Children as young as 1 year old use words to express pain.
c. The childs behavioral, physiologic, and verbal responses are valuable when assessing pain.
d. Pain assessment tools are minimally effective for communicating about pain.

ANS: C

Feedback
A The childs age is important in determining the appropriate pain assessment tool to use.
B Developmentally appropriate assessment tools need to be used to effectively identify and determine the level of pain felt by a child. Toddlers may use words such as ouch or hurt to identify pain, but infants and young children may not have the language or cognitive abilities to express pain.
C Childrens behavioral, physiologic, and verbal responses are indicative when assessing pain. The use of pain measurement tools greatly assists in communicating about pain.
D Pain assessment tools when used appropriately are successful and efficient in identifying and quantifying pain with children. Behavioral and physiologic signs and symptoms in combination with pain assessment tools are most effective in diagnosing pain levels in children.

DIF: Cognitive Level: Application REF: Text Reference: pgs 398-399
OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

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